Cardiac questions Test #2

ATI: A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? 1. assess for tinnitus 2. report urine output 50mL/hr 3. monitor serum K levels 4. elevate the HOB slowly before ambulation 5. recommend eating a banana daily

1,3,4,5

A client recieving a loop diuretic should be encouraged to eat which foods? Select all that apply: 1. angel food cake 2. banana 3. dried fruit 4. orange juice 5. peppers

2,3,4 (Hypokalemia is a side effect of loop diuretics. Bananas, dried fruit, and oranges are examples of foods high in K. Angel food cake and peppers are low in K)

hydralazine and ISDN

AA Male with HF exacerbation. Takes: Lisinopril, Metoprolol, Furosemide and Dig. What drug should be recommended to decrease mortality? a. Bumetanide b. Digoxin c. Hydralazine and ISDN d. Valsartan

alpha-1 blockade

ACEi affect remodeling process by all of the following processes EXCEPT: a. bradykinin/NO b. RAAS activation modulation c. Sympathetic nervous system modulation d. Alpha-1 blockade e. Decreased aldosterone secretion

left atrial hypertrophy

Common myocardial pathology associated with HTN, Ischemic heart disease, HF, and valve disease that promotes electrophysiological alterations that result in A.Fib: a. Fibrosis of the SA node b. Fibrosis of the AV node c. Left atrial hypertrophy d. Left ventricular hypertrophy

ANS:A Defibrillation is always indicated in the treatment of ventricular fibrillation.

For which dysrhythmia is defibrillation primarily indicated? A. Ventricular fibrillation B. Third-degree AV block C. Uncontrolled atrial fibrillation D. Ventricular tachycardia with a pulse

over diuresis leading to hypotension, fatigue, and renal impairment

Potential adverse effects associated with loop diuretics in treatment of CHF may include: a. Over diuresis leading to hypotension, fatigue, and renal impairment b. Hyperkalemia c. Hypermagnesemia d. All of the above e. None of the above

A patient has recently started taking oral digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for control of heart failure. Which assessment finding by the home health nurse is most important to communicate to the health care provider

Serum potassium level is 3.0 mEq/L after 1 week of therapy

false

The NYHA classes are determined by the development of structural changes within the heart and progression of heart failure, whereas ACCF/AHA are based on symptoms a. True b. False

either A or B are appropriate choices

The choices for subsequent treatment for termination of PSVT if the primary drug of choice is unsuccessful are based on presence or absence of heart failure as demonstrated by LVEF. Which drugs would be preferred in the patients presenting with an EF of 28%? a. Digoxin b. Amiodarone c. Verapamil d. Propranolol e. Either A or B are appropriate choices

ANS: B

The emergency department patient is in paroxysmal supraventricular tachycardia (PSVT) at a rate of 170 beats/minute. Which treatment do you anticipate first? A. Sotalol (Betapace) by slow IVP B. Adenosine (Adenocard) by fast IVP C. Defibrillation D. Digoxin (Lanoxin)

ANS: B A change in the level of consciousness should always have glucose and oxygen (and cardiac) assessed first.

The female patient presents to the emergency department just after a syncope episode. What should you assess first? A. History of syncope B. Capillary glucose level C. Last menstrual period D. Allergies

c. left ventricular dysfunction

The most common finding in individuals at risk for sudden cardiac death is a. aortic valve disease b. mitral valve disease c. left ventricular dysfunction d. atherosclerotic heart disease

B (Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output. Petechiae, fever, chills, and diaphoresis are symptoms of IE, but are not caused by decreased cardiac output. An increase in pulse rate of 15 beats/minute is normal with exercise.)

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on which assessment finding(s)? a. Fever, chills, and diaphoresis b. Urine output less than 30 mL/hr c. Petechiae on the inside of the mouth and conjunctiva d. Increase in heart rate of 15 beats/minute with walking

B Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets.

The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Multifocal premature ventricular contractions

The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: A Headache B High blood pressure C Shortness of breath D Stomach cramps

a

A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? A "Eat foods high in potassium." B "Take daily potassium supplements." C "Discontinue sodium restrictions." D "Avoid salt substitutes.

d

Furosemide is administered IV to a client with HF. How soon after administration should the nurse begin to see evidence of the drugs desired effect? 1. 5-10 min 2. 30-60 min 3. 2-4 hrs 4. 6-8 hrs

1 (After IV injection of furosemide, diuresis normally begins in about 5 min. and reaches its peak within about 30 mins. Medication effects last 2-4 hrs. When furosemide is given IM or orally , drug action begins more slowly and lasts longer than when given IV)

Metoprolol is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension who has been initially treated with furosemide and ramipril. An expected therapeutic effect is: 1. decrease in HR 2. lessening of fatigue 3. improvement in blood sugar level 4. increase in urine output

1 (The effect of a beta blocker is a decrease in HR, contractility and afterload, which leads to a decrease in BP.. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output)

The client is receiving pentoxifylline for intermittant claudication. The nurse should determine the effectiveness of the drug by asking if the client: 1. has less pain in the legs 2. can wiggle the toes 3. is urinating more frequently 4. is less dizzy

1 (although pentoxifylline 's precise mechanism of action in unknown, its therapeutic effect is to increase blood flow, and the client should have improved circ in the legs as evident by less pain. The client does not have nerve impairment and should be able to wiggle the toes. Urination is not improved by taking this med. Dizziness is a side effect of this drug not an intended outcome)

ATI: A nurse is teaching a client who has a new prescription for verapamil to control HTN. Which of the following instructions should the nurse include? 1. increase dietary fiber 2. drink grapefruit juice to increase vitamin C 3. decrease the amount of Ca in the the diet 4. withhold food for 1 hr after the med is taken

1 (increasing dietary fiber intake can help prevent constipation, and adverse effect of verapamil. Clients SHOULD NOT drink grapefruit juice. )

ATI: A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? 1. asthma 2. glaucoma 3. hypertension 4. tachycardia

1 (propanolol is a nonselective beta blocker that can block beta receptors in the lungs which causes bronchoconstiction)

ATI: A nurse is proving information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? 1. take the med with food 2. plan to take the med at bed time 3. expect increased swelling around the ankles 4. fluid intake should be limited in the morning

1 (take with food)

ATI: A nurse is teaching a client who has a new prescription for digoxin to treat her HF. Which of the following instructions should the nurse include in the teaching? 1. contact the HCP if heart rate is <60/min 2. check pulse rate for 30 seconds and multiply result by 2 3. increase intake of Na 4. take with food if nausea occurs

1 (the client should contact the HCP for a HR less than 60 bpm. The client should check pulse rate for 1 full minute before each dose. The client should reduce Na and avoid excess fluids. The client should report nausea to the provider because it is a manifestation of dig toxicity)

The nurse is teaching the client with HTN about taking atenolol. The nurse should instruct the client to: 1. avoid sudden D/C of the drug 2. monitor BP annually 3. follow a 2-g Na diet 4. D/C the med if severe headaches develop

1 (atenolol is a beta-adrenergic antagonist indicated for mngmt of HTN. Sudden D/C of the drug is dangerous because it may exacerbate symptoms. The med should not be D/C without a prescription. BP needs to be monitored more frequently than annually in a client who is newly diagnosed and treated for HTN. Clients are not usually placed on a 2-g Na diet for HTN.)

The nurse is preparing teaching to a client about prescribed spironolactone and to monitor for adverse effects of the drug. The nurse would instruct the client about which adverse effect? Select all that apply 1. confusion 2. fatigue 3. hypertension 4. leg cramps 5. weakness 6. urinary retention

1,2,5 (spironolactone is used to treat HTN and edema by removing excess fluids. Spironolactone is known as a K sparing diuretic. Confusion, fatigue and weakness are signs of hyperkalemia, an adverse affect of spironolactone. Leg cramps are a sign of HYPOkalemia. Urinary retention would be sign of anticholinergics)

ATI: A nurse is providing teaching to a client who has a new prescription for digoxin. The urse should instruct the client to monitor and report which of the following adverse effects that is a manifestation of digoxin toxicity? Select all that apply. 1. fatigue 2. constipation 3. anorexia 4. rash 5. diplopia

1,3,5 (fatigue and weakness are early CNS signs that can indicate toxicity. N/V/D (not constipation are GI manifestations of toxicity. Rash is not an indication. Visual changes such as diplopia and yellow tinged vision are manifestations of dig toxicity)

order N terminal pro BNP to correlate biomarker for congestion

1. A pt comes into the ED with an NSTEMI and LVEF at 30-35%. He takes: ASA, Metoprolol, Enalapril, Digoxin, Rosuvastatin, Furosemide, Metformin, and APAP. What is the most appropriate therapeutic intervention? a. Check serum digoxin level for therapeutic goal of 1.2-2.0 b. Order N terminal pro BNP to correlate biomarker for congestion c. Order cardiac troponin T to correlate biomarker with signs of congestion None of the above interventions are clinically indicated

orthopnea

what is the medical term for the symptom of "feels short of breath when lying down at night" a. orthopnea b. hepatojugular reflux c. pulmonary congestion d. paroxysmal nocturnal dyspnea e. peripheral edema

efficacy of ACEis is a class effect

which of the following is TRUE regarding ACEis in heart failure? a. efficacy of ACEis is a class effect b. should be discontinued if creatinine clearance decreases by more than 10% c. should be used mainly in severe heart failure, NYHA functional class IV d. can be replaced by ARBs if the patient has hypertension e. may be used in place of hydrazine and isosorbide denigrate in cases of renal dysfunction

C Rationale: Dental procedures place the patient with a prosthetic mitral valve at risk for infectious endocarditis (IE).

1. The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis. Which question by the nurse is most appropriate? a. "Do you have a history of a heart attack?" b. "Have you any recent immunizations?" c. "Have you been to the dentist lately?" d. "Is there a family history of endocarditis?"

B The mitral area location is at the intersection of the fifth intercostal space and the midclavicular line. The murmur is a pansystolic murmur.

1. While listening at the mitral area, the nurse notes abnormal heart sounds at the patient's fifth intercostal space, midclavicular line. After listening to the audio clip, describe how the nurse will document the assessment finding a. S3 gallop heard at the aortic area b. Systolic murmur noted at mitral area c. Diastolic murmur noted at tricuspid area d. Pericardial friction rub heard at the apex

A Rationale: Dysrhythmias can occur as the catheter is floated through the right atrium and ventricle, and it is important for the nurse to monitor for these during insertion.

11. When preparing to assist with the insertion of a pulmonary artery catheter, the nurse will anticipate the need to a. place the patient on a cardiac monitor. b. administer diuretics before the procedure. c. auscultate heart sounds during insertion. d. check cardiac enzymes before insertion.

A Rationale: The PAWP indicates that the patient's preload is elevated and furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase myocardial oxygen demand and might extend the MI.

13. A patient with a myocardial infarction (MI) and cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. Hemodynamic monitoring reveals an elevated PAWP and decreased cardiac output. The nurse will anticipate a. administration of furosemide (Lasix) IV. b. titration of an epinephrine (Adrenalin) drip. c. administration of a normal saline bolus. d. assisting with endotracheal intubation.

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations of the adverse effects of daily aspirin therapy? 1. hypertension 2. coffee-ground emesis 3, tinnitus 4. paresthesias of the extremities 5. nausea

2,3,5

ANS: B Diagnostic testing (e.g., stress test, Holter monitor, electrophysiologic studies, cardiac catheterization) is used to determine the possible cause of the SCD and treatment options. SCD is likely to recur.

20. When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient that a. sudden cardiac death events rarely reoccur. b. additional diagnostic testing will be required. c. long-term anticoagulation therapy will be needed. d. limiting physical activity will prevent future SCD events.

Ans: D: Monitoring of the pulmonary artery diastolic and pulmonary artery wedge pressures is particularly important in critically ill patients because it is used to evaluate left ventricular filling pressures (i.e., left ventricular preload).

36. A critical care nurse is caring for a patient with a pulmonary artery catheter in place. What does this catheter measure that is particularly important in critically ill patients? A) Pulmonary artery systolic pressure B) Right ventricular afterload C) Pulmonary artery pressure D) Left ventricular preload

metoprolol 50 mg BID

65 y/o Male with HTN and CAD. Takes: HCTZ, Enalapril, Amlodipine. Intermittent palpitations and light-headed. 6-10 PVCs/hour. HR 82 bpm. What is appropriate? a. Amiodarone 400 mg daily b. Flecainide 150 mg Q12H c. Metoprolol 50 mg BID d. No treatment should be initiated

B In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks.

A 19-year-old student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take next? a. Start supplemental O2 at 2 to 3 L/min via nasal cannula. b. Ask the patient about current stress level and caffeine use. c. Ask the patient about any history of coronary artery disease. d. Have the patient taken to the hospital emergency department (ED).

adenosine

A 23-year-old female who has a history of supraventricular tachycardia is having an acute episode again. She has attempted a valsalva maneuver without success in breaking the arrhythmia. The ECG confirms SVT. What is the next step in therapy for this patient? a. acebutolol b. atropine c. amiodarone d. amiodipine e. adenosine

enalapril (ACEi)

A 68 y/o white male comes into the office with hx of HTN, CHF, T1DM. He is diagnosed with HF secondary to CVD and hyperlipidemia. What is the best drug to start? a. Clonidine (Alpha 2 Agonist) b. Enalapril (ACEi) c. Ranolazine (Anti-Ischemic) d. Nifedipine (CCB) Prazosin (Alpha 1 Blocker

C (Aspirin, oxygen, nitroglycerin, and morphine sulfate are all commonly used to treat acute chest pain suspected to be caused by myocardial ischemia.

A 72-year-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question? A. Aspirin B. Oxygen C. Nitroglycerin D. Morphine sulfate

C. Neurohormonal response.

A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is: A. Ventricular dilation. B. Ventricular hypertrophy. C. Neurohormonal response. D. Sympathetic Nervous System activation.

ANS: C Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea, and chest pain. Adenosine has no conclusive impact on intraocular pressure.

A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response? a. Decreased intraocular pressure b. Increased heart rate c. Short period of asystole d. Hypertensive crisis

ANS: B For safety during cardioversion, the nurse should turn off any oxygen therapy to prevent fire. The other interventions are not appropriate for a cardioversion. The client should be placed in a supine position.

A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action should the nurse take prior to the initiation of cardioversion? a. Administer intravenous adenosine. b. Turn off oxygen therapy. c. Ensure a tongue blade is available. d. Position the client on the left side.

ANS: A, D, E Elevated heart rates in a healthy client initially cause blood pressure and cardiac output to increase.

A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations should the nurse assess? (Select all that apply.) a. Decrease in cardiac output b. Increase in cardiac output c. Decrease in blood pressure d. Increase in blood pressure e. Decrease in urine output f. Increase in urine output

ANS: A To ensure the best signal transmission, the skin should be clean and hairs clipped. Electrodes should be placed on the anterior chest, and no additional gel is needed. Oxygen has no impact on electrocardiographic monitoring.

A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring. Which statement should the nurse provide to the UAP related to this procedure? a. "Clean the skin and clip hairs if needed." b. "Add gel to the electrodes prior to applying them." c. "Place the electrodes on the posterior chest." d. "Turn off oxygen prior to monitoring the client."

send the pt to an ED for evaluation and treatment

A patient comes into the clinic with a history of syncope and weakness for 2-3 days. The PA notes a thready, rapid pulses and a 3 second capillary refill. EKG reveals a heart rate of 198 bpm and regular rhythm. The PA should: a. Administer intravenous fluids and obtain serum electrolytes b. Administer amiodarone in the clinic and observe closely for response c. Order dig and verapamil and ask patient to return for follow up in 1 week d. Send the patient to an ED for evaluation and treatment

ANS: C Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation.

A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as a. orthopnea. b. pulsus alternans. c. paroxysmal nocturnal dyspnea. d. acute bilateral pleural effusion.

ANS: D Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients with acute decompensated heart failure (ADHF) because of the risk of worsening the HF

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? a. Furosemide (Lasix) 60 mg b. Captopril (Capoten) 25 mg c. Digoxin (Lanoxin) 0.125 mg d. Carvedilol (Coreg) 3.125 mg

After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first?

A patient who is cool and clammy, with new-onset confusion and restlessness

ANS: B Fibrinolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI), so the time at which the chest pain started is a major determinant of the appropriateness of this treatment.

A patient with ST segment elevation in several electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy? a. "Do you take aspirin on a daily basis?" b. "What time did your chest pain begin?" c. "Is there any family history of heart disease?" d. "Can you describe the quality of your chest pain?"

A The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate.

A patient's cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? a. Perform immediate defibrillation. b. Give epinephrine (Adrenalin) IV. c. Prepare for endotracheal intubation. d. Give ventilations with a bag-valve-mask device.

B The carotid pulses should never be palpated at the same time to avoid vagal stimulation, dysrhythmias, and decreased cerebral blood flow.

A registered nurse (RN) is observing a student nurse who is doing a physical assessment on a patient. The RN will need to intervene immediately if the student nurse a. presses on the skin over the tibia for 10 seconds to check for edema. b. palpates both carotid arteries simultaneously to compare pulse quality. c. documents a murmur heard along the right sternal border as a pulmonic murmur. d. places the patient in the left lateral position to check for the point of maximal impulse.

ANS: C The patient will need to be NPO for 6 hours preceding the TEE, so the nurse should place the patient on NPO status as soon as the order is received.

A transesophageal echocardiogram (TEE) is ordered for a patient with possible endocarditis. Which of these actions included in the standard TEE orders will the nurse need to accomplish first? a. Administer O2 per mask. b. Start a large-gauge IV line. c. Place the patient on NPO status. d. Give lorazepam (Ativan) 1 mg IV.

III

According to Vaughn-Williams, Amiodarone is classified as class: a. 1A b. 1B c. IC d. II e. III

both A and B

Actions of Beta Blockers: a. Decreased heart rate b. Decrease automaticity of atrial muscle c. Increase automaticity of SA node d. Increase AV conduction e. Both A and B

B When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the systemic vascular resistance (SVR) and blood pressure, and improve tissue perfusion.

After receiving 2 L of normal saline, the central venous pressure for a patient who has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an order for a. nitroglycerine (Tridil). b. norepinephrine (Levophed). c. sodium nitroprusside (Nipride). d. methylprednisolone (Solu-Medrol).

all of the above

Antiarrhythmic drugs which may be used based on underlying heart disease and comorbidities to maintain sinus rhythm for experience sxs despite maximum tolerated doses of drugs so rate control include: a. Amiodarone b. Flecainide c. Sotalol d. Propafenone e. All of the above

C. Vasodilation of peripheral vasculature Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption & demand. Vasodilation in coronary arteries & collateral vessels may also increase blood flow to the ischemic areas of the heart.

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principle effects are produced by: a. Antispasmotic effect on the pericardium b. Causing an increased mycocardial oxygen demand c. Vasodilation of peripheral vasculature d. Improved conductivity in the myocardium

A "I will limit the amount of milk and cheese in my diet." Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet.

At a clinic visit, the nurse provides dietary teaching for a 56-year-old woman who was recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? A "I will limit the amount of milk and cheese in my diet." B "I can add salt when cooking foods but not at the table." C "I will take an extra diuretic pill when I eat a lot of salt." D "I can have unlimited amounts of foods labeled as reduced sodium

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse take first?

Auscultate the lung sounds.

An outpatient who has heart failure returns to the clinic after 2 weeks of therapy with carvedilol (Coreg). Which of these assessment findings is most important for the nurse to report to the health care provider?

BP of 88/42 mm Hg

patients who tolerate an ACEi or an ARB but still have Sxs

Based on 2016 Focused Update HF Guideline, the use of ARNI is indicated for: a. Patient who do not tolerate an ACEi or an ARB b. As an add on to and ACE Inhibitor or an ARB in patients who need additional symptom relief c. Patients who tolerate an ACE inhibitor or an ARB but still have symptoms d. Patients with class IV heart failure None of the above

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%?

Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

furosemide (we want fluid management)

CAD, fatigue, SOB, JVD, S3, Rales. Takes: ACEi, ASA, Metoprolol. What med is best to add? a. Furosemide b. Ranolazine c. Valsartan d. Verapamil

Clopidogrel (Plavix)

DP is a 48 yo female with IHD who is allergic to aspirin. Which of the following should DP receive as an alternative to aspirin therapy? a. Clopidogrel (Plavix) b. Warfarin c. Dipyridamole (persantine) d. Naproxen (Naprosyn) e. No antiplatelet therapy is necessary

Milrinone (Inotrope) - Good for pt already on B-blockers

Drug termed "inodilator": a. Dopamine (Inotropes) b. Milrinone (Inotrope) - Good for pts already on B-Blockers c. Amiodarone (K+ Channel Blocker) d. Ranolazine (Anti-Ischemic - usually added to B-Blockers or Nitrates) e. Epinephrine (Vasoconstrictor)

C A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in oxygen saturation, are normal responses to exercise. DIF: Cognitive Level: Apply (application) REF: 761 TOP: Nursing Process: Evaluation MSC:

Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response to the activity, which assessment data would indicate that the exercise level should be decreased? a. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg. b. Oxygen saturation drops from 99% to 95%. c. Heart rate increases from 66 to 92 beats/minute. d. Respiratory rate goes from 14 to 20 breaths/minute.

verapamil

Heart rate is maximally decreased by: a. Nitrates b. Nifedipine c. Verapamil d. Diltiazem e. Hydralazine

1 year

How long should clopidogrel be given along with aspirin after angioplasty and drug-eluting stent placement? a. 1 day b. 1 week c. 1 month d. 6 months e. 1 year

A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing actions included in the plan of care. Which action will be best for the RN to delegate to an experienced LPN/LVN?

Monitor the patient's BP and heart rate every hour.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid action by the nurse?

Oxygen saturation of 88%

aspirin

Regardless of the choice of acute management, whether the patient undergoes fibrinolysis, PCI with stenting, or CABG, _____________ is the mainstay of antiplatelet therapy. a. Clopidogrel b. Ticagrelor c. Prasugrel d. Aspirin e. Warfarin

tell the patient that treatment is not indicated

Routine EKG shows PVCs. No hx of heart disease, no complaint. PA should: a. Prescribed quinide (Quinidex Extentabs) b. Tell the patient that treatment is not indicated c. Refer patient to a cardiologist for evaluation d. Consider using amiodarone if the patient develops other symptoms

choices B, C, and D

Select all ions that regulate heart activity: a. Cl b. Ca c. NA d. K e. Choices B, C and D

B Rationale: Lack of information is a major source of anxiety for family members and should be addressed first. Family members should be prepared for the patient's appearance and the ICU environment before visiting the patient for the first time.

Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first? a. Take the family member members to the patient's room. b. Describe the patient's injuries and the care that is being provided. c. Discuss ICU visitation policies and encourage family visits. d. Invite the family to participate in a multidisciplinary care conference.

C. Take one tablet, then an additional tablet every 5 mins for a total of 3 tablets. Call the physician if pain persists after 3 tablets.

Sublingual Nitroglycerin tablets begin to work within 1-2 mins. How should the nurse instruct the client to use the drug when chest pain occurs? A. Take one tablet every 2-5 mins until the pain stops B. Take one tablet & rest for 10 mins. Call the physician if pain persists after 10 mins. C. Take one tablet, then an additional tablet every 5 mins for a total of 3 tablets. Call the physician if pain persists after 3 tablets. D. Take one tablet. If pain persists after 5 mins, take 2 tablets. If pain still persists 5 mins later, call the physician.

ANS: D A premature ventricular contraction (PVC) is a contraction originating in an ectopic focus in the ventricles. When every other beat is a PVC, the rhythm is called ventricular bigeminy.

The ECG monitor of a patient in the cardiac care unit after a myocardial infarction (MI) indicates ventricular bigeminy with a rate of 50 beats/minute. You anticipate A. performing defibrillation. B. treatment with IV lidocaine. C. insertion of a temporary, transvenous pacemaker. D. assessing the patient's response to the dysrhythmia

Ans: B Feedback: PAPM is used to assess left ventricular function. CVP is used to assess right ventricular function; SAPM is used for continual assessment of BP. ABG are used to assess for acidic and alkalotic levels in the blood.

The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patient's left ventricular function? A) Central venous pressure (CVP) monitoring B) Pulmonary artery pressure monitoring (PAPM) C) Systemic arterial pressure monitoring (SAPM) D) Arterial blood gases (ABG)

D Sounds from the mitral valve are best heard at the apex of the heart, fifth intercostal space, midclavicular line.

The nurse is caring for a patient with mitral regurgitation. Referring to the figure below, where should the nurse listen to best hear any murmur that the patient has? a. 1 b. 2 c. 3 d. 4

C Serum potassium level Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity.

The nurse prepares to administer digoxin (Lanoxin) 0.125 mg to an 82-year-old man admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? A Prothrombin time B Urine specific gravity C Serum potassium level D Hemoglobin and hematocrit

D (Nonsteroidal antiinflammatory drugs (NSAIDs) will control pain and inflammation.

The patient with pericarditis is complaining of chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief? A. Corticosteroids B. Morphine sulfate C. Proton pump inhibitor D. Nonsteroidal antiinflammatory drugs

effect of afterload-reducing vasodilators in detouring blood from coronary arteries

The phenomenon described as "coronary steal" refers to: a. Effect that beta blocker have in decreasing heart rate b. Effect of calcium channel... c. Effect of afterload-reducing vasodilators in detouring blood from coronary arteries d. Effect that quinidine has on the QT-interval None of the above

36 hours

The recommended washout period in patients on an ACE inhibitor who are prescribed Entresto (ACE must be stopped this long before the entresto can start_

only B and C

Treatment with which of the following drug classes has/have been shown to improve the survival of patients treatment for heart failure? a. Cardiac glycosides such as Digoxin b. Beta adrenergic blockers such as Metoprolol c. Combination of Hydralazine and Isosorbide Dinitrate d. Only B and C e. All of the Above

should be used in all NYHA functional classes

True regarding ACEi and ARB in CHF? a. Should be used in all NYHA functional classes b. Should be added once the patient is symptomatic c. Are less efficacious than hydralazine and ISDN d. Should be used together in all NYHA functional class IV patients e. ARBs cannot be substituted for ACE inhibitors due to increased risk of renal toxicity

metoprolol ( is the most selective)

What beta-blockers would be preferred in the treatment of heart failure for a patient predisposed to symptomatic HTN? a. Atenolol b. Labetalol c. Carvedilol d. Metoprolol e. All of the above are excellent choices

hydralazine/nitrates

What is the most appropriate vasodilator therapy for a patient with HR, LVSD and hx of Losartan-induced angioedema? a. Lisinopril b. Candesartan c. Hydralazine / nitrates Diltiazem

potassium

What should be monitored closely in a patient taking Ranolazine? a. Respiratory rate b. Sodium c. Potassium d. Heart rate e. Hematocrit

ANS: C B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as they do with heart failure.

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

ANS: B Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (F) waves. There are no normal P waves because the atria are not contracting, just fibrillating.

You are watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead, there are fine, wavy lines between the QRS complexes. The QRS complexes each measure 0.08 second (narrow), but they occur irregularly with a rate of 120 beats/minute. You correctly interpret that this rhythm is A. sinus tachycardia. B. atrial fibrillation. C. ventricular fibrillation. D. ventricular tachycardia.

Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the nitroprusside rate if the patient develops

a systolic BP <90 mm Hg.

During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain, and complains of "feeling too tired to do anything." Based on these data, the best nursing diagnosis for the patient is

activity intolerance related to fatigue.

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to

administer IV morphine sulfate 2 mg.

Following an acute myocardial infarction, a previously healthy 67-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about rational:ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure

angiotensin-converting enzyme (ACE) inhibitors.

A patient with chronic heart failure who has prescriptions for a diuretic, an ACE-inhibitor, and a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurse's first action will be to

assess the patient for clinical manifestations of acute heart failure.

The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient

calls the clinic when the weight increases from 124 to 130 pounds in a week.

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is

decreased dyspnea with the head of bed at 30 degrees

ANS: A Although all options will be assessed eventually, determining a cardiac cause for this brief lapse of consciousness is most important. Reference: 839

elderly patient presents to the emergency department after a fall. She states she does not remember the incident. What is most important to assess first? A. Heart rate and rhythm B. Hemoglobin C. Home environment D. Alcohol consumption

During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates

elevated right atrial pressure. rational:

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL).

notify the health care provider about any nausea.

A patient who has chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment information as

paroxysmal nocturnal dyspnea.

While admitting an 80-year-old with heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the patient's discharge the nurse will facilitate

referral to a home health care agency.

ANS: B IV administration of amiodarone may cause bradycardia and atrioventricular (AV) block. The correct action for the nurse to take at this time is to slow the infusion, because the client is asymptomatic and no evidence reveals AV block that might require pacing.

After assessing a client who is receiving an amiodarone intravenous infusion for unstable ventricular tachycardia, the nurse documents the findings and compares these with the previous assessment findings: Vital Signs Nursing Assessment Time: 0800, Temp: 98° F HR: 68 bts/min, BP: 135/60 mm Hg RR: 14 breaths/min, O2 sat.: 96% Oxygen: 2 L nasal cannula Time: 10:00, Temp: 98.2° F, HR: 50 bts/min BP: 132/57 mm Hg RR: 16 breaths/min O2 sat: 95% O2: 2 L nasal cannula Time: 0800, Client alert and oriented. Cardiac rhythm: normal sinus rhythm. Skin: warm, dry, and appropriate for race. Resp equal and unlabored. Client denies sob and chest pain. Time: 1000, Client alert and oriented. Cardiac rhythm: sinus bradycardia. Skin: warm, dry, and appropriate for race. Resp equal and unlabored. Client denies shortness of breath and chest pain. Client voids 420 mL of clear yellow urine. Based on the assessments, which action should the nurse take? a. Stop the infusion and flush the IV. b. Slow the amiodarone infusion rate. c. Administer IV normal saline. d. Ask the client to cough and deep breathe.

C The patient has an elevated low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol, which will increase the risk of coronary artery disease. nonsmoker.

After reviewing information shown in the accompanying figure from the medical records of a 43-year-old, which risk factor modification for coronary artery disease should the nurse include in patient teaching? a. Importance of daily physical activity b. Effect of weight loss on blood pressure c. Dietary changes to improve lipid levels d. Ongoing cardiac risk associated with history of tobacco use

ANS: B The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields. Clients should avoid tight clothing, which could cause irritation over the ICD generator.

After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching? a. "I should wear a snug-fitting shirt over the ICD." b. "I will avoid sources of strong electromagnetic fields." c. "I should participate in a strenuous exercise program." d. "Now I can discontinue my antidysrhythmic medication."

A Atropine will increase the heart rate and conduction through the AV node.

After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patient's heart rate b. Increase in strength of peripheral pulses c. Decrease in premature atrial contractions d. Decrease in premature ventricular contractions

ANS: C The emergency medical services (EMS) system should be activated when chest pain or other symptoms are not completely relieved 5 minutes after taking one nitroglycerin.

After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? a. "I can expect indigestion as a side effect of nitroglycerin." b. "I can only take the nitroglycerin if I start to have chest pain." c. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." d. "I will help slow down the progress of the plaque formation by taking nitroglycerin."

ANS: A Patients who have been taking -blockers can develop intense and frequent angina if the medication is suddenly discontinued. Atenolol (Tenormin) decreases myocardial contractility.

After the nurse teaches the patient about the use of atenolol (Tenormin) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. "It is important not to suddenly stop taking the atenolol." b. "Atenolol will increase the strength of my heart muscle." c. "I can expect to feel short of breath when taking atenolol." d. "Atenolol will improve the blood flow to my coronary arteries."

ANS: D ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure.

Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations. b. -adrenergic blockers. c. calcium channel blockers. d. angiotensin-converting enzyme (ACE) inhibitors.

b. abnormal levels of cholesterol, especially low-density lipoproteins c. accumulation of lipid and fibrous tissue within the coronary arteries d. development of angina due to a decreased blood supply to the heart muscle

In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply) a. diffuse involvement of plaque formation in coronary veins b. abnormal levels of cholesterol, especially low-density lipoproteins c. accumulation of lipid and fibrous tissue within the coronary arteries d. development of angina due to a decreased blood supply to the heart muscle e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm

ANS: C Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias. The other responses do not adequately address the client's question.

The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, "Why do you want to know if I use cocaine?" How should the nurse respond? a. "Substance abuse puts clients at risk for many health issues." b. "The hospital requires that I ask you about cocaine use." c. "Clients who use cocaine are at risk for fatal dysrhythmias." d. "We can provide services for cessation of substance abuse."

A (Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic stenosis. A PMI at the left midclavicular line is normal.)

The nurse is caring for a 78-year-old patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider? a. The patient complains of chest pressure when ambulating. b. A loud systolic murmur is heard along the right sternal border. c. A thrill is palpated at the second intercostal space, right sternal border. d. The point of maximum impulse (PMI) is at the left midclavicular line.

C The elevation in troponin T and I indicates that the patient has had an acute myocardial infarction. Further assessment and interventions are indicated.

The nurse is reviewing the laboratory results for newly admitted patients on the cardiovascular unit. Which patient laboratory result is most important to communicate as soon as possible to the health care provider? a. Patient whose triglyceride level is high b. Patient who has very low homocysteine level c. Patient with increase in troponin T and troponin I level d. Patient with elevated high-sensitivity C-reactive protein level

Too much hair under the electrodes Artifact is caused by muscle activity, electrical interference, or insecure leads and electrodes that could be caused by excessive chest wall hair.

The nurse is seeing artifact on the telemetry monitor. Which factors could contribute to this artifact? Disabled automaticity Electrodes in the wrong lead Too much hair under the electrodes Stimulation of the vagus nerve fibers

Myocardial ischemia The ST depression and T wave inversion on the ECG of a patient diagnosed with ACS indicate myocardial ischemia from inadequate supply of blood and oxygen to the heart.

The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? Myocardia injury Myocardial ischemia Myocardial infarction A pacemaker is present.

C Rationale: The mean arterial pressure (MAP) is calculated using the formula MAP = (systolic BP + 2 diastolic BP)/3. The MAP for the postoperative patient in answer 3 is 67. The MAP in the other three patients is higher than 70 mm Hg.

The standard orders on the cardiac unit state, "Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg." The nurse will need to call the health care provider about a. the patient with left ventricular failure who has a BP of 110/70. b. the patient with a myocardial infarction who has a BP of 114/50. c. the postoperative patient with a BP 116/42. d. the newly admitted patient with a BP of 122/60.

all of these are correct

Use the MOA of ACEi to determine the physiologic action that results in treatment of CHF: a. ACE inhibitors reduce the formation of angiotensin II b. ACE Inhibitors promote the excretion of Na and H2O from kidneys c. ACE inhibitors decrease the inactivation of bradykinin d. All of these are correct

B A bruit is the sound created by turbulent blood flow in an artery.

When auscultating over the patient's abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a a. thrill. b. bruit. c. murmur. d. normal finding.

B. During diastolic Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole.

When do coronary arteries primarily receive blood flow? A. During inspiration B. During diastolic C. During expiration D. During systole

Rate 200 beats/min; P wave not visible VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible.

Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)? Unmeasurable rate and rhythm Rate 150 beats/min; inverted P wave Rate 200 beats/min; P wave not visible Rate 125 beats/min; normal QRS complex

ANS: C VT is associated with a rate of 150 to 250 beats/minute, and the P wave is not normally visible. P-wave inversion and a normal QRS complex are not associated with VT.

Which ECG characteristics are consistent with a diagnosis of ventricular tachycardia (VT)? A. Unmeasurable rate and rhythm B. Rate of 150 beats/minute; inverted P wave C. Rate of 200 beats/minute; P wave not visible D. Rate of 125 beats/minute; normal QRS complex

C The nurse will need to teach the patient that the procedure is rapid and involves little risk. None of the other actions are necessary.

Which action will the nurse implement for a patient who arrives for a calcium-scoring CT scan? a. Insert an IV catheter. b. Administer oral sedative medications. c. Teach the patient about the procedure. d. Confirm that the patient has been fasting.

B The changes in the right hand indicate compromised blood flow, which requires immediate evaluation and actions such as prescribed calcium channel blockers or surgery. The other changes are expected and/or require nursing interventions.

Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision

choices A, B, and C

Which of the following are types of supraventricular arrhythmias: a. Premature atrial contractions b. Paroxysmal atrial tachycardia c. Atrial flutter d. Premature ventricular contractions e. Choices A, B, and C

digoxin

Which of the following medications would be preferred for control of ventricular response inpatients with atrial fibrillation and heart failure? a. verapamil b. digoxin c. diltiazem d. dofelitide

angiotensin receptor blocker - serum creatinine (SCr), potassium serum

Which of the following statements regarding monitoring for adverse effects is correct? a. metoprolol - HR, angioedema b. Angiotensin Receptor Blocker- Serum Creatinine (SCr), potassium serum c. Statin- creatinine kinase, CBC Eptifibatide- activated partial thromboplastin time, SCr

C. The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers

Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? A. The length of time it takes to depolarize the atrium B. The length of time it takes for the atria to depolarize and repolarize C. The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers D. The length of time it takes for the electrical impulse to travel from the SA node to the AV node

A (Pericarditis can lead to cardiac tamponade, an emergency situation.

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? A. Pulsus paradoxus B. Prolonged PR intervals C. Widened pulse pressure D. Clubbing of the fingers

The laboratory results of a patient diagnosed with heart failure shows a serum digoxin (Lanoxin) level of 2.1 ng/mL. Which medication is appropriate to administer at this time? A Digoxin immune fab (DigiFab) B Potassium chloride (K-tab) C Furosemide (Lasix) D An increased dose of digoxin (Lanoxin)

a

A patient diagnosed with heart failure has been prescribed digoxin (Lanoxin). Which of the following will the healthcare provider include when teaching the patient about this medication? Choose all answers that apply: A "You should keep a record of your daily weights." B "If your pulse is less than 60 beats per minute, do not take the medication." C "Call our office if you experience nausea or lack of appetite." D "If you miss a dose, you should double the dose next time." E "Increase dietary sodium to maintain your fluid balance." F "Report any visual changes to our office immediately."

a,b,c,f

ANS: A Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute kidney injury and death in some patients who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued. The other symptoms are common side effects when taking niacin, and although the nurse should follow-up with the health care provider, they do not indicate that a change in medication is needed.

26. A patient who has recently started taking pravastatin and niacin reports the following symptoms to the nurse. Which is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Dizziness when changing positions quickly c. Nausea when taking the drugs before eating d. Flushing and pruritus after taking the medications

The nurse should teach the client that signs of digoxin toxicity include: 1. rash over the chest and back 2. increased appetitie 3. visual disturbances such as seeing yellow spots 4. elevated BP

3 (colored vision and seeing yellow spots are symptoms of digoxin toxicity. Abd pain, anorexia, N/V are other common symptoms of digoxin toxicity. Additional signs of toxicity include arrythmias, such as atrial fibrillation or bradycardia. Rash, increase appetite and elevated BP are not associated with digoxin toxicity.)

A client is admitted with a diagnosis of thrombophlebitis and DVT of the right leg. A loading dose of Heparin has been given in the ER., and IV heparin will be continued for the next several days. The nurse should develop a plan of care for this client that will involve: 1. adminstering aspirin as prescribed 2. encouraging leafy green vegetables in the diet 3. monitoring the clients prothrombin time (PT) 4. monitoring the clients activated partial thromboplastin tims (aPTT) and international normalized ratio (INR)

4 (Heparin dosage is usually determined by the HCP based on the clients aPTT and INR lab values. Therefore the nurse monitors these values to prevent complications. Administering aspirin when the client is on heparin in contraindicated. Green leafy veges are high in Vit K and therefore are not recommended for clients receiving heparin. Monitoring the clients PT is done when the client is receiving warfarin sodium)

ANS: C The emergency medical services (EMS) system should be activated when chest pain is not relieved or is worse after taking a single dose of NTG before taking any additional doses. If symptoms are significantly improved after 1 dose, the patient can take 2 more doses 5 minutes apart for a total of 3 doses. If pain not completely relieved, EMS should be called. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse). Gastric upset (e.g., nausea) is not an expected side effect of nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis.

5. After the nurse has finished teaching a patient about the use of sublingual nitroglycerin, which patient statement indicates that the teaching has been effective? a. "I can expect some nausea as a side effect of nitroglycerin." b. "I should only take the nitroglycerin if I start to have chest pain." c. "I will call an ambulance if I still have pain 5 minutes after taking 1 nitroglycerin." d. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."

give IV furosemide to decrease congestion Sxs and evidence of fluid retention

63 yo Hispanic male presents to the ED with increased shortness of breath, 3 pillow orthopnea, weight gain of 6 pounds in the past week.... HM's physical exam shows positive JVP, 1+ pitting edema, normal S1 &S2 heart sounds, and mild crackles at bases in lungs, bilaterally. Which of the following is the best pharmacological intervention for HM at this time? a. Hold ACEi since blood pressure is controlled and serum creatinine is elevated b. Add spironolactone 25 mg daily for benefit since he has systolic HF and is symptomatic c. Give IV Furosemide to decrease congestion symptoms and evidence of fluid retention Add HYD-ISDN to alleviate symptoms and reduce risks of rehospitalization and mortality

27 In order to administer the dobutamine at the prescribed rate of 5 mcg/kg/minute from a concentration of 250 mg in 250 mL, the nurse will need to infuse 27 mL/hour.

A 198-lb patient is to receive a dobutamine infusion at 5 mcg/kg/minute. The label on the infusion bag states: dobutamine 250 mg in 250 mL normal saline. When setting the infusion pump, the nurse will set the infusion rate at how many mL per hour?

A In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the family's health history. Dyspnea during an aerobic activity such as soccer is normal.

A 20-year-old has a mandatory (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54, and the student denies any health problems. What action by the nurse is most appropriate? a. Allow the student to participate on the soccer team. b. Refer the student to a cardiologist for further diagnostic testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the student's family health history.

D Rationale: Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient.

A 21-year-old woman is scheduled for an open mitral valve commissurotomy for treatment of mitral stenosis. When explaining the advantage of valve repair instead of valve replacement to the patient, the nurse will include the information that a. mechanical mitral valves require replacement about every 10 years. b. no antibiotic prophylaxis to prevent endocarditis is needed after valve repair. c. biologic replacement valves require the use of life-long immunosuppressive drugs. d. long-term anticoagulation is necessary after mechanical valve replacement.

C (Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed.)

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? a. Biologic valves will require immunosuppressive drugs after surgery. b. Mechanical mitral valves need to be replaced sooner than biologic valves. c. Lifelong anticoagulant therapy will be needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

C (Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults.

A 25-year-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. What should the nurse tell the patient to encourage the patient to take the medications and avoid complications of the infection? A. "The complications of this infection will affect the skin, hair, and balance." B. "You will not feel well if you do not take the medicine and get over this infection." C. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." D. "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

ANS: B Indications for a heart transplant include end-stage heart failure (Stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered.

A 53-year-old patient with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most appropriate? a. "Because you have diabetes, you would not be a candidate for a heart transplant." b. "The choice of a patient for a heart transplant depends on many different factors." c. "Your heart failure has not reached the stage in which heart transplants are needed." d. "People who have heart transplants are at risk for multiple complications after surgery."

D (Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms indicating cardiac tamponade include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure.

A 55-year-old female patient develops acute pericarditis after a myocardial infarction. It is most important for the nurse to assess for which clinical manifestation of a possible complication? A. Presence of a pericardial friction rub B. Distant and muffled apical heart sounds C. Increased chest pain with deep breathing D. Decreased blood pressure with tachycardia

D Rationale: Indications for a heart transplant include inoperable coronary artery disease and refractory end-stage heart failure, but other factors such as coping skills, family support, and patient motivation to follow the rigorous post-transplant regimen are also considered

A 55-year-old patient with inoperable coronary artery disease and end-stage heart failure asks the nurse whether heart transplant is a possible therapy. The nurse's response to the patient will be based on the knowledge that a. heart transplants are experimental surgeries that are not covered by most insurance. b. the patient is too old to be placed on the transplant list. c. the diagnoses and symptoms indicate that the patient is not an appropriate candidate. d. candidacy for heart transplant depends on many factors.

C. Take a nitroglycerin tablet before climbing the stairs. Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free.

A 56-year-old woman felt twinges of chest pain while working in her garden & has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. diagnosis of stable angina pectoris. After stabilization and discharge She states that she is visiting a friend twice a week & now cannot walk up the second flight of steps to the friend's apartment w/o pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem? a. Visit her friend earlier in the day. b. Rest for at least an hour before climbing the stairs. c. Take a nitroglycerin tablet before climbing the stairs. d. Lie down once she reaches the friend's apartment.

A. Administer the morphine Although obtaining the ECG, chest x-ray, & blood work are all important, the nurse's priority action would be to relieve the crushing chest pain.

A 60 year old male client comes into the ER with complaints of crushing chest pain that radiates to his shoulder & left arm. The admitting diagnosis is acute MI. Immediate admission orders include oxygen by NC at 4L/min, blood work, chest x-ray, an ECG, & 2 mg of morphine given intravenously. The nurse should first: A. Administer the morphine B. Obtain a 12-lead ECG C. Obtain the lab work D. Order the chest x-ray

IV amiodarone

A 65-year-old man was admitted to the cardiac intensive care unit today with an exacerbation of heart failure due to a hypertensive crisis. Echocardiogram reveals a left ventricular ejection fraction of 35% [0.35]. He also has a past history of hypertension and dyslipidemia. While in the cardiac intensive care unit, the patient complains of palpitations and light-headedness, and his blood pressure is 105/70 mm Hg. ECG reveals ventricular tachycardia at a rate of 125 beats/min, which lasts longer than 30 seconds and does not terminate on its own. Which one of the following is the most appropriate treatment? a. IV pocainamide b. IV verapamil c. no treatment necessary d. immediate direct current ardioversion e. IV amiodarone

perform TEE; if no thrombus is present, cardiovert; anticoagulant for at least 4 weeks post cardioversion

A 66-year-old male with a past medical history of congestive heart failure and hypertension is receiving lisinopril 10 mg po qd, digoxin 0.25 mg po qd, carvedilol 25 mg bid, and spironolactone 25 mg po qd at home. He now presents to the emergency room with a 1-week history of intermittent palpitations and dizziness. The EGG reveals atrial fibrillation with a ventricular rate of 130 bpm. The decision is made to attempt to restore normal sinus rhythm. Which of the following represents the best therapeutic approach to cardioverting the patient? a. anticoagulation for 2 weeks prior to cardioversion; continue anticoagulation for at least 4 weeks postcardioversion b. perform TEE; if no thrombus is present, cardiovert; there is no need for anticoagulation c. Perform TEE; if no thrombus is present, cardiovert; anticoagulant for at least 4 weeks postcardioversion d. anticoagulate for 4 weeks prior to cardioversion; discontinue anticoagulation postcardioversion e. direct current cardiovert immediately

C. Within the therapeutic range The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus.

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: A. The same as the client's own baseline level B. Lower than the needed therapeutic level C. Within the therapeutic range D. Higher than the therapeutic range

ANS: B Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes in mentation, speech, sensory function, and motor function.

A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition? a. Sinus tachycardia b. Speech alterations c. Fatigue d. Dyspnea with activity

ANS: A Chest pain, possibly angina, indicates that tachycardia may be increasing the client's myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace.

A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse? a. Mid-sternal chest pain b. Increased urine output c. Mild orthostatic hypotension d. P wave touching the T wave

ANS: D Sinus rhythm with PVCs has an underlying regular sinus rhythm with ventricular depolarization that sometimes precede atrial depolarization.

A nurse assesses a client's electrocardiogram (ECG) and observes the reading shown below: How should the nurse document this client's ECG strip? a. Ventricular tachycardia b. Ventricular fibrillation c. Sinus rhythm with premature atrial contractions (PACs) d. Sinus rhythm with premature ventricular contractions (PVCs)

ANS: D Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization.

A nurse assesses a client's electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation? a. The client has hyperkalemia causing irregular QRS complexes. b. Ventricular tachycardia is overriding the normal atrial rhythm. c. The client's chest leads are not making sufficient contact with the skin. d. Ventricular and atrial depolarizations are initiated from different sites.

ANS: B Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in slowing of the heart rate. Such a response is not desirable in a person who has bradycardia. The other instructions are not appropriate for this condition.

A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate? a. "Make certain that your bath water is warm." b. "Avoid straining while having a bowel movement." c. "Limit your intake of caffeinated drinks to one a day." d. "Avoid strenuous exercise such as running."

ANS: A Ventricular tachycardia occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min or more. Ventricular tachycardia is a lethal dysrhythmia. The nurse should first assess if the client is alert and breathing. Then the nurse should call a Code Blue and begin CPR.

A nurse cares for a client who is on a cardiac monitor. The monitor displayed the rhythm shown below: Which action should the nurse take first? a. Assess airway, breathing, and level of consciousness. b. Administer an amiodarone bolus followed by a drip. c. Cardiovert the client with a biphasic defibrillator. d. Begin cardiopulmonary resuscitation (CPR).

ANS: B In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the chest wall. The pacemaker spike should be followed immediately by a QRS complex.

A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiogram. Which action should the nurse take next? a. Administer intravenous diltiazem (Cardizem). b. Assess vital signs and level of consciousness. c. Administer sublingual nitroglycerin. d. Assess capillary refill and temperature.

ANS: C Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing activities of daily living. The nurse should schedule periods of exercise and rest during the day to decrease fatigue.

A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions should the nurse implement to address this client's concerns? a. Administer oxygen therapy at 2 liters per nasal cannula. b. Provide the client with a sleeping pill to stimulate rest. c. Schedule periods of exercise and rest during the day. d. Ask unlicensed assistive personnel to help bathe the client.

ANS: B Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulant, such as heparin, enoxaparin, or warfarin.

A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client's medication administration record to prevent a common complication of this condition? a. Sotalol (Betapace) b. Warfarin (Coumadin) c. Atropine (Sal-Tropine) d. Lidocaine (Xylocaine)

ANS: D To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and ensures their compliance before delivery of the shock

A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client? a. Make sure the defibrillator is set to the synchronous mode. b. Administer 1 mg of intravenous epinephrine. c. Test the equipment by delivering a smaller shock at 100 joules. d. Ensure that everyone is clear of contact with the client and the bed.

ANS: A The home health nurse needs to know current medications the client is taking to ensure assessment, evaluation, and further education related to these medications.

A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services. Which priority information should be communicated to the home health nurse upon discharge? a. Medication reconciliation b. Immunization history c. Religious beliefs d. Nutrition preferences

ANS: A PACs usually have no hemodynamic consequences. For a client experiencing infrequent PACs, the nurse should explore possible lifestyle causes, such as excessive caffeine intake and stress. Lying on the side will not prevent or resolve PACs.

A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement should the nurse include in this client's teaching? a. "Minimize or abstain from caffeine." b. "Lie on your side until the attack subsides." c. "Use your oxygen when you experience PACs." d. "Take amiodarone (Cordarone) daily to prevent PACs."

ANS: A, B, E The client should not submerge in water until the site has healed; after the incision is healed, the client may take showers or baths without concern for the pacemaker. The client should be instructed to report changes in heart rate or rhythm, such as rates lower than the pacemaker setting or greater than 100 beats/min.

A nurse teaches a client with a new permanent pacemaker. Which instructions should the nurse include in this client's teaching? (Select all that apply.) a. "Until your incision is healed, do not submerge your pacemaker. Only take showers." b. "Report any pulse rates lower than your pacemaker settings." c. "If you feel weak, apply pressure over your generator." d. "Have your pacemaker turned off before having magnetic resonance imaging (MRI)." e. "Do not lift your left arm above the level of your shoulder for 8 weeks."

ANS: C The rhythm is a second-degree AV block, type I (Mobitz I or Wenckebach heart block). The rhythm is identified by a gradual lengthening of the PR interval. Type I AV block is usually a result of myocardial ischemia or infarction and typically is transient and well tolerated. You should assess for bradycardia, hypotension, and angina. If the patient becomes symptomatic, atropine or a temporary pacemaker may be needed.

A patient admitted with acute coronary syndrome (ACS) has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate of 74 beats/minute and regular; ventricular rate of 62 beats/minute and irregular; P wave with a normal shape; PR interval that lengthens progressively until a P wave is not conducted; and QRS complex with a normal shape. Your priority nursing intervention involves A. performing synchronized cardioversion. B. admin 1 mg of epinephrine by IVP. C. observing for symptoms of hypotension or angina. D. preparing the patient for a transcutaneous pacemaker.

D (The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure.

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder? a. A heart transplant should be scheduled as soon as possible. b. Elevating the legs above the heart will help relieve dyspnea. c. Careful compliance with diet and medications will prevent heart failure. d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

D The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response.

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which actions should the nurse take next? a. Recheck the heart rhythm and BP in 5 minutes. b. Have the patient perform the Valsalva maneuver. c. Give the scheduled dose of diltiazem (Cardizem). d. Apply the transcutaneous pacemaker (TCP) pads.

B Leads II, III, and AVF reflect the inferior area of the heart and the ST segment changes. Lead II will best capture any (ECG) changes that indicate further damage to the myocardium.

A patient has ST segment changes that support an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient? a. I b. II c. V2 d. V6

C If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60 beats/minute.

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/minute. a. 15 to 20 b. 20 to 40 c. 40 to 60 d. 60 to 100

D First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block.

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a. notify the health care provider immediately. b. give atropine per agency dysrhythmia protocol. c. prepare the patient for temporary pacemaker insertion. d. document the finding and continue to monitor the patient.

ANS: C Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions), and potentiate the actions of digoxin and increase the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias.

A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

ANS: A A head-up tilt test is a common component of the diagnostic workup after episodes of syncope.

A patient has sought care after an episode of syncope of unknown origin. Which nursing action should you prioritize in the patient's subsequent diagnostic workup? A. Preparing to assist with a head-up tilt test B. Assessing the patient's knowledge of pacemakers C. Preparing an intravenous dose of a β-adrenergic blocker D. Teaching the patient about the role of antiplatelet aggregators

Preparing to assist with a head-up tilt-test In patients without structural heart disease, the head-up tilt-test is a common component of the diagnostic workup following episodes of syncope.

A patient has sought care following a syncopal episode of unknown etiology. Which nursing action should the nurse prioritize in the patient's subsequent diagnostic workup? Preparing to assist w/a head-up tilt-test Preparing an IV dose of a β-adrenergic blocker Assessing the patient's knowledge of pacemakers Teaching the patient about the role of antiplatelet aggregators

ANS: A Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea.

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurse's priority action will be a. give IV morphine sulfate 4 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

A (Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization and 24-hour Holter monitor is not a diagnostic procedure for pericarditis.)

A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of a. echocardiography. b. daily blood cultures. c. cardiac catheterization. d. 24-hour Holter monitor.

c. Begin an exercise program that aims for at least five 30-minute sessions per week

A patient is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in the teaching plan? a. Refrain from sexual activity for a minimum of 3 weeks b. Plan a diet program that aims for a 1- to 2-pound weight loss per week c. Begin an exercise program that aims for at least five 30-minute sessions per week d. Consider the use of erectile agents and prophylactic NTG before engaging in sexual activity

C (The pain associated with pericarditis is caused by inflammation, so nonsteroidal antiinflammatory drugs (NSAIDs) (e.g., ibuprofen) are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.)

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which ordered PRN medication will be the most appropriate for the nurse to give? a. Fentanyl 1 mg IV b. IV morphine sulfate 4 mg c. Oral ibuprofen (Motrin) 600 mg d. Oral acetaminophen (Tylenol) 650 mg

C The inconsistency between the atrial and ventricular rates and the variable P-R interval indicate that the rhythm is third-degree AV block. Sinus rhythm with PACs will have a normal rate and consistent P-R intervals with occasional PACs.

A patient reports dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as a. junctional escape rhythm. b. accelerated idioventricular rhythm. c. third-degree atrioventricular (AV) block. d. sinus rhythm with premature atrial contractions (PACs).

d) Cardiac dysrhythmias The most common complication after MI is dysrhythmias, which are present in 80% of patients. Unstable angina is considered a precursor to MI rather than a complication.

A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate? a) Unstable angina b) Cardiac tamponade c) Sudden cardiac death d) Cardiac dysrhythmias

C The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that reperfusion therapy can begin as quickly as possible.

A patient who has chest pain is admitted to the emergency department (ED) and all of the following are ordered. Which one should the nurse arrange to be completed first? a. Chest x-ray b. Troponin level c. Electrocardiogram (ECG) d. Insertion of a peripheral IV

A The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of severe hypotension caused by vasodilation. The other home medications also should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment. DIF: Cognitive Level: Apply (application) REF: 745 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC:

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Sildenafil (Viagra) b. Furosemide (Lasix) c. Captopril (Capoten) d. Warfarin (Coumadin)

C The patient has sinus tachycardia, which may have multiple etiologies such as pain, dehydration, anxiety, and myocardial ischemia. Further assessment is needed before determining the treatment. Vagal stimulation or -blockade may be used after further assessment of the patient.

A patient who is complaining of a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next? a. Prepare to perform electrical cardioversion. b. Have the patient perform the Valsalva maneuver. c. Obtain the patient's vital signs including oxygen saturation. d. Prepare to give a -blocker medication to slow the heart rate.

C Because this patient has dyspnea and chest pain in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by starting with oxygen administration.

A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the patient's vital signs including oxygen saturation.

ANS: C An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN.

A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Assess the IV insertion site for signs of extravasation. b. Teach the patient the reasons for remaining on bed rest. c. Monitor the patient's blood pressure and heart rate every hour. d. Titrate the rate to keep the systolic blood pressure >90 mm Hg.

D The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes.

A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next? a. Immediately notify the health care provider. b. Document the rhythm and continue to monitor the patient. c. Perform synchronized cardioversion per agency dysrhythmia protocol. d. Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.

B The patient's clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.

A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take? a. Perform synchronized cardioversion. b. Start cardiopulmonary resuscitation (CPR). c. Administer atropine per agency dysrhythmia protocol. d. Provide supplemental oxygen via non-rebreather mask.

B The PAWP indicates that the patient's preload is elevated, and furosemide is indicated to reduce the preload and improve cardiac output.

A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations 28. The pulmonary artery wedge pressure (PAWP) is increased and cardiac output is low. The nurse will anticipate an order for which medication? a. 5% human albumin b. Furosemide (Lasix) IV c. Epinephrine (Adrenalin) drip d. Hydrocortisone (Solu-Cortef)

ANS: C The 5-pound weight gain over 3 days indicates that the patient's chronic heart failure may be worsening. It is important that the patient be assessed immediately for other clinical manifestations of decompensation, such as lung crackles.

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurse's priority action will be to a. have the patient recall the dietary intake for the last 3 days. b. ask the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of restricting dietary sodium.

C The purpose for angiotensin-converting enzyme (ACE) inhibitors in patients with chronic stable angina who are at high risk for a cardiac event is to decrease ventricular remodeling. ACE inhibitors do not directly impact angina frequency, blood glucose, or heart rate.

A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten). The nurse should teach the patient that the primary purpose of captopril is to a. lower heart rate. b. control blood glucose levels. c. prevent changes in heart muscle. d. reduce the frequency of chest pain.

A Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion.

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about a. anticoagulant therapy. b. permanent pacemakers. c. electrical cardioversion. d. IV adenosine (Adenocard).

D The bile acid sequestrants interfere with the absorption of many other drugs, and giving other medications at the same time should be avoided.

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is most appropriate when giving the medication? a. Have the patient take this medication with an aspirin. b. Administer the medication at the patient's usual bedtime. c. Have the patient take the colesevelam with a sip of water. d. Give the patient's other medications 2 hours after the colesevelam.

B (The patient's joint pain will lead to difficulty with activity. The skin lesions seen in rheumatic fever are not open or pruritic. Although acute joint pain will be a problem for this patient, joint inflammation is a temporary clinical manifestation of rheumatic fever and is not associated with permanent joint changes.)

A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. Based on these findings, which nursing diagnosis would be most appropriate? a. Pain related to permanent joint fixation b. Activity intolerance related to arthralgia c. Risk for infection related to open skin lesions d. Risk for impaired skin integrity related to pruritus

D The patient has progressive first-degree atrioventricular (AV) block, and the -blocker should be held until discussing the medication with the health care provider.

A patient's cardiac monitor shows sinus rhythm, rate 64. The P-R interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next? a. Place the transcutaneous pacemaker pads on the patient. b. Administer atropine sulfate 1 mg IV per agency dysrhythmia protocol. c. Document the patient's rhythm and assess the patient's response to the rhythm. d. Call the health care provider before giving the next dose of metoprolol (Lopressor).

ANS: C A heart rate of 40 beats/min or less with widened QRS complexes could have hemodynamic consequences. The client is at risk for inadequate cerebral perfusion.

A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment should the nurse complete next? a. Pulmonary auscultation b. Pulse strength and amplitude c. Level of consciousness d. Mobility and gait stability

B

A transesophageal echocardiogram (TEE) is ordered for a patient with possible endocarditis. Which action included in the standard TEE orders will the nurse need to accomplish first? a. Start an IV line. b. Place the patient on NPO status. c. Administer O2 per nasal cannula. d. Give lorazepam (Ativan) 1 mg IV.

A 55-year-old with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is appropriate?

"The choice of a patient for a heart transplant depends on many different factors."

You are caring for a hospitalized client with heart failure who is receiving captopril (Capoten) and spironolactone (Aldactone). Which laboratory value will be most important to monitor? 1. Sodium level 2. Blood urea nitrogen level 3. Potassium level 4. Alkaline phosphatase level

3 (Hyperkalemia is a common adverse effect of both ACE inhibitors and potassium-sparing diuretics. The other laboratory values may be affected by these medications but are not as likely or as potentially life threatening. Focus: Prioritization)

C Rationale: For accurate measurement of pressures, the zero-reference level should be at the phlebostatic axis. There is no need to rebalance and recalibrate monitoring equipment hourly.

7. The ICU charge nurse will evaluate that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse a. balances & calibrates the hemodynamic monitoring equipment every hour. b. ensures that the pt is lying supine with the head of the bed flat for all readings. c. positions the zero-ref stopcock line level with the phlebostatic axis. d. positions limb w/the catheter insertion site at zero-ref of the stopcock line.

ANS: C This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring.

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse do first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Assess the level of orientation.

ANS: D Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis.

A patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin? a. Platelet aggregation is enhanced by IV heparin infusion. b. Heparin will dissolve the clot that is blocking blood flow to the heart. c. Coronary artery plaque size and adherence are decreased with heparin. d. Heparin will prevent the development of new clots in the coronary arteries.

amiodarone

Ataxia, pulmonary fibrosis, skin discoloration and thyroid disturbances are adverse effects of: a. Verapamil b. procainamide c. Amiodarone d. Disopyramide

C (Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. This will require frequent international normalized ratio (INR) testing. Daily aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.)

During discharge teaching with a 68-year-old patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient on the a. use of daily aspirin for anticoagulation. b. correct method for taking the radial pulse. c. need for frequent laboratory blood testing. d. need to avoid any physical activity for 1 month.

B Rationale: The formula for CO is stroke volume heart rate. Because the PAWP and SVR are unchanged, the patient's stroke volume is stable, so a drop in heart rate has occurred to decrease the CO. Measures to improve heart rate should be implemented.

During hemodynamic monitoring, the nurse finds that a patient has decreased cardiac output (CO) without changes in pulmonary artery wedge pressure (PAWP) or systemic vascular resistance (SVR). The nurse anticipates assisting with interventions to a. reduce stroke volume. b. increase heart rate. c. lower right atrial pressure (RAP). d. reduce central venous pressure (CVP).

B Rationale: Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. There is no need to avoid high-voltage electrical fields.

During postoperative teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding a. the need to avoid high-voltage electrical fields. b. how to monitor anticoagulation therapy. c. the need for valve replacement in 7 to 10 years. d. how to check the radial pulse.

B (New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure. Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.)

During the assessment of a 25-year-old patient with infective endocarditis (IE), the nurse would expect to find a. substernal chest pressure. b. a new regurgitant murmur. c. a pruritic rash on the chest. d. involuntary muscle movement.

ANS: C A change in heart rate of more than 20 beats or more indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in oxygen saturation, are normal responses to exercise. DIF: Cognitive Level: Application REF: 792

Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response, which of these assessment data would indicate that the exercise level should be decreased? a. BP changes from 118/60 to 126/68 mm Hg. b. Oxygen saturation drops from 100% to 98%. c. Heart rate increases from 66 to 90 beats/minute. d. Respiratory rate goes from 14 to 22 breaths/minute.

ANS: A The patient data indicates that ineffective coping after the MI caused by anxiety about the impact of the MI is a concern. The other nursing diagnoses may be appropriate for some patients after an MI, but the data for this patient do not support denial, activity intolerance, or social isolation. DIF: Cognitive Level: Application REF: 788-789

Four days after having a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with all the daily activities, saying, "I am too nervous to take care of myself." Based on this information, which nursing diagnosis is appropriate? a. Ineffective coping related to anxiety b. Activity intolerance related to weakness c. Denial related to lack of acceptance of the MI d. Social isolation related to lack of support system

B and C

HM has LVEF of 35% on echocardiogram and he is planned for discharge. Which of the following are appropriate considerations at discharge? a. Decrease metoprolol succinate ER dose from 200 mg to 150 mg daily because of concerns for hypotension and bradycardia in this patient b. Counsel about avoiding the use of NSAIDS/ COX 2 inhibitors for pain c. Ensure follow up appointment, check renal fxn and serum K+ level within 2-3 days to follow strict monitoring guideline recommendation B and C

D. Protamine sulfate The antidote to heparin is protamine sulfate & should be readily available for use if excessive bleeding or hemorrhage should occur.

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? A. Vitamin K B. Aminocaporic acid C. Potassium chloride D. Protamine sulfate

ANS: C Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication.

IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

spironolactone leads more frequently to gynecomastia compared to eplerenone

Mineralocorticoid receptor antagonists (or aldosterone receptor antagonists) have been shown to reduce mortality in patients with heart failure. Which of the following is TRUE about MRAs? a. can only be used in NYHA functional class IV b. added to loop diuretic when a patient is resistant to its effects to enhance removal of fluids c. used after maximizing ACEis, B-blockers, and digoxin d. associated with hypokalemia e. spironolactone leads more frequently to gynecomastia compared to eplerenone

C. Make a commitment to long-term therapy The priority goal is compliance.

The most important long-term goal for a client with HTN would be to: A. Learn how to avoid stress B. Explore a job change or early retirement C. Make a commitment to long-term therapy D. Control high BP

B UAP can be educated in standardized lead placement for ECG monitoring. Assessment of patients who have had procedures where airway maintenance (transesophageal echocardiography) or bleeding (coronary angiogram) is a concern must be done by the registered nurse (RN).

The nurse and unlicensed assistive personnel (UAP) on the telemetry unit are caring for four patients. Which nursing action can be delegated to the UAP? a. Teaching a patient scheduled for exercise electrocardiography about the procedure b. Placing electrodes in the correct position for a patient who is to receive ECG monitoring c. Checking the catheter insertion site for a patient who is recovering from a coronary angiogram d. Monitoring a patient who has just returned to the unit after a transesophageal echocardiogram

B (A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.)

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? A. Respiratory rate of 18 and heart rate of 90 B. Regurgitant murmur at the mitral valve area C. Heart rate of 94 and capillary refill time of 2 seconds D. Point of maximal impulse palpable in fourth intercostal space

D (Patients with a history of rheumatic fever are more susceptible to a second episode. Patients with rheumatic fever without carditis require prophylaxis until age 20 and for a minimum of 5 years. The other patient statements are correct and would not support the nursing diagnosis of ineffective health maintenance.)

The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge regarding long-term management of rheumatic fever when a 30-year-old recovering from rheumatic fever without carditis says which of the following? a. "I will need prophylactic antibiotic therapy for 5 years." b. "I will need to take aspirin or ibuprofen (Motrin) to relieve my joint pain." c. "I will call the doctor if I develop excessive fatigue or difficulty breathing." d. "I will be immune to further episodes of rheumatic fever after this infection."

D (Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep breaths will tend to increase pericardial pain.

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The priority intervention by the nurse for this problem is to a. teach the patient to take deep, slow breaths to control the pain. b. force fluids to 3000 mL/day to decrease fever and inflammation. c. remind the patient to request opioid pain medication every 4 hours. d. place the patient in Fowler's position, leaning forward on the overbed table.

ANS: C This patient is at risk for bleeding from the arterial access site for the PCI, so the nurse should assess the patient's blood pressure, pulse, and the access site immediately. The other patients also should be assessed as quickly as possible, but assessment of this patient has the highest priority.

The nurse has just received change-of-shift report about the following four patients. Which patient should the nurse assess first? a. 38-year-old who has pericarditis and is complaining of sharp, stabbing chest pain b. 45-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge c. 51-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI) d. 60-year-old with variant angina who is to receive a scheduled dose of nifedipine (Procardia)

D The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first? a. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago b. A patient with new onset atrial fibrillation, rate 88, who has a first dose of warfarin (Coumadin) due c. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating d. A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due

C Cardiac troponins start to elevate 4 to 6 hours after myocardial injury and are highly specific to myocardium. They are the preferred diagnostic marker for myocardial infarction.

The nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The most important laboratory result to review will be a. myoglobin. b. low-density lipoprotein (LDL) cholesterol. c. troponins T and I. d. creatine kinase-MB (CK-MB).

ANS: A The S1 signifies the onset of ventricular systole. S2 signifies the onset of diastole. A murmur occurring between these two sounds is a systolic murmur.

The nurse hears a murmur between the S1 and S2 heart sounds at the patient's left 5th intercostal space and midclavicular line. How will the nurse record this information? a. "Systolic murmur heard at mitral area." b. "Diastolic murmur heard at aortic area." c. "Systolic murmur heard at Erb's point." d. "Diastolic murmur heard at tricuspid area."

A The S1 signifies the onset of ventricular systole. S2 signifies the onset of diastole.

The nurse hears a murmur between the S1 and S2 heart sounds at the patient's left fifth intercostal space and midclavicular line. How will the nurse record this information? a. Systolic murmur heard at mitral area b. Systolic murmur heard at Erb's point c. Diastolic murmur heard at aortic area d. Diastolic murmur heard at the point of maximal impulse

B (Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor for rheumatic fever, and would not be as pertinent when admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.)

The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history will be most pertinent to ask? a. "Do you use any illegal IV drugs?" b. "Have you had a recent sore throat?" c. "Have you injured your chest in the last few weeks?" d. "Do you have a family history of congenital heart disease?"

A (Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics.

The nurse is caring for a 64-year-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately? a. The patient has bilateral crackles. b. The patient has bilateral, 4+ peripheral edema. c. The patient has a loud systolic murmur across the precordium. d. The patient has a palpable thrill felt over the left anterior chest.

ANS: B The client's rhythm is ventricular fibrillation. This is a lethal rhythm that is best treated with immediate defibrillation. While the nurse is waiting for the defibrillator to arrive, the nurse should start CPR.

The nurse is caring for a client on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below: After calling for assistance and a defibrillator, which action should the nurse take next? a. Perform a pericardial thump. b. Initiate cardiopulmonary resuscitation (CPR). c. Start an 18-gauge intravenous line. d. Ask the client's family about code status.

Ans: C The normal CVP is 2 to 6 mm Hg. Many problems can cause an elevated CVP, but the most common is due to hypervolemia. Assessing the patient and informing the physician are the most prudent actions.

The nurse is caring for a patient who has central venous pressure (CVP) monitoring in place. The nurse's most recent assessment reveals that CVP is 7 mm Hg. What is the nurse's most appropriate action? A) Arrange for continuous cardiac monitoring and reposition the patient. B) Remove the CVP catheter and apply an occlusive dressing. C) Assess the patient for fluid overload and inform the physician. D) Raise the head of the patient's bed and have the patient perform deep breathing exercise, if possible.

C. Assessing the incision for any redness, swelling, or discharge After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site.

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time? A. Reinforcing the pressure dressing as needed B. Encouraging range-of-motion exercises of the involved arm C. Assessing the incision for any redness, swelling, or discharge D. Applying wet-to-dry dressings every 4 hours to the insertion site

"I cannot fly because it will damage the ICD." The patient statement that flying will damage the ICD indicates misunderstanding about flying. The patient should be taught that informing TSA about the ICD can be done because it may set off the metal detector and if a hand-held screening wand is used, it should not be placed directly over the ICD.

The nurse is doing discharge teaching with the patient and spouse of the patient who just received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates to the nurse that the patient needs more teaching? "I will call the cardiologist if my ICD fires." "I cannot fly because it will damage the ICD." "I cannot move my left arm until it is approved." "I cannot drive until my cardiologist says it is okay."

b) Pathologic Q wave The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion.

The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion? a) Sinus tachycardia b) Pathologic Q wave c) Fibrillatory P waves d) Prolonged PR interval

A (The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.)

The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include? A. Prompt recognition and treatment of streptococcal pharyngitis B. Completion of 4 to 6 days of antibiotic therapy for infective endocarditis of respiratory infections in children born with heart defects C. Avoidance of respiratory infections in children who have rheumatoid arthritis D. Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis

Atrial fibrillation represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just fibrillating. rval.

The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets this rhythm as what? Sinus tachycardia Atrial fibrillation Ventricular fibrillation Ventricular tachycardia

D This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer.

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. c. Calculate the number of small squares between one QRS complex and the next and divide into 1500. d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.

B. Third-degree heart block Third-degree heart block represents a loss of communication between the atrium and ventricles from AV node dissociation. This is depicted on the rhythm strip as no relationship between the P waves (representing atrial contraction) and QRS complexes (representing ventricular contraction).

The nurse obtains a 6-second rhythm strip and charts the following analysis: Tab 1 Atrial data, Rate: 70, regular Variable PR interval, Independent beats Tab 2 Ventricular data Rate: 40, regular, Isolated escape beats Tab 3 Additional data QRS: 0.04 sec, P wave and QRS complexes unrelated What is the correct interpretation of this rhythm strip? A. Sinus arrhythmias B. Third-degree heart block C. Wenckebach phenomenon D. Premature ventricular contractions

D (Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk factors for IE.)

The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. "Do you have a history of a heart attack?" b. "Is there a family history of endocarditis?" c. "Have you had any recent immunizations?" d. "Have you had dental work done recently?"

D The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate ventricular tachycardia.

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as a. atrial flutter. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

ANS: D The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme (ACE) inhibitors for the patient. Elevation in cardiac troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI. DIF: Cognitive Level: Application REF: 779-780

The nurse obtains the following data when caring for a patient who experienced an acute myocardial infarction (AMI) 2 days previously. Which information is most important to report to the health care provider? a. The patient denies ever having a heart attack. b. The cardiac-specific troponin level is elevated. c. The patient has occasional premature atrial contractions (PACs). d. Crackles are auscultated bilaterally in the mid-lower lobes.

B (Patients with infective endocarditis should inform their dental providers of their health history. Antibiotic prophylaxis is recommended for patients with a history of infective endocarditis who have certain dental procedures performed.

The nurse performs discharge teaching for a 68-year-old man who is newly diagnosed with infective endocarditis with a history of IV substance abuse. Which statement by the patient indicates to the nurse that teaching was successful? A."I will need antibiotics before having any invasive procedure or surgery." B. "I will inform my dentist about my hospitalization for infective endocarditis." C."I should not be alarmed if I have difficulty breathing or pink-tinged sputum." D. "An elevated temperature is expected and can be managed by taking acetaminophen."

ANS: C Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. limit dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider if nausea develops. d. skip the digoxin if the pulse is below 60 beats/minute.

B (Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.)

The nurse provides discharge instructions for a 40-year-old woman who is newly diagnosed with cardiomyopathy. Which statement, if made by the patient, indicates that further teaching is necessary? A."I will avoid lifting heavy objects." B. "I can drink alcohol in moderation." C."My family will need to take a CPR course." D. "I will reduce stress by learning guided imagery."

D. Myocardial infarction Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred.

The nurse receives emergency lab results for a client with chest pain & immediately informs the physician. An increased myoglobin level suggests which of the following? A. Cancer B. Hypertension C. Liver disease D. Myocardial infarction

A. Decreased EF and increased PAWP. Systolic heart failure results in systolic failure in the left ventricle (LV). The LV loses its ability to generate enough pressure to eject blood forward through the aorta.

The nurse recognizes that primary manifestations of systolic failure include: A. Decreased EF and increased PAWP. B. Decreased PAWP and increased EF. C. Decreased pulmonary hypertension associated with normal EF. D. Decreased afterload and decreased left-ventricular end-diastolic pressure.

A (Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle. The other methods described would not be useful in determining the presence of pulsus paradoxus.)

The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should a. note when Korotkoff sounds are auscultated during both inspiration and expiration. b. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP). c. check the electrocardiogram (ECG) for variations in rate during the respiratory cycle. d. listen for a pericardial friction rub that persists when the patient is instructed to stop breathing.

A. Headache Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, & dizziness.

The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: A. Headache B. High BP C. Shortness of breath D. Stomach cramps

D The patient is instructed to keep a diary describing daily activities while Holter monitoring is being accomplished to help correlate any rhythm disturbances with patient activities. Patients are taught that they should not take a shower or bath

The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to a. connect the recorder to a computer once daily. b. exercise more than usual while the monitor is in place. c. remove the electrodes when taking a shower or tub bath. d. keep a diary of daily activities while the monitor is worn.

C (Current American Heart Association guidelines recommend the use of prophylactic antibiotics before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at risk for IE.)

The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for which patient? a. Patient admitted with a large acute myocardial infarction. b. Patient being discharged after an exacerbation of heart failure. c. Patient who had a mitral valve replacement with a mechanical valve. d. Patient being treated for rheumatic fever after a streptococcal infection.

ANS: D Patients taking -blockers should be monitored for bradycardia. Because this category of medication inhibits the sympathetic nervous system, restlessness, agitation, hypertension, and anxiety will not be side effects.

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if a. the patient is restless and agitated. b. the blood pressure is 190/110 mm Hg. c. the patient complains about feeling anxious. d. the cardiac monitor shows a heart rate of 45.

ANS: C Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week.

The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide (Lasix) every day at bedtime. b. the nitroglycerin patch is applied when any chest pain develops. c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. d. an additional pillow can help her sleep if she is feeling short of breath at night.

b) Acute coronary syndrome (ACS) The pain with ACS is severe, prolonged, and not easy to relieve. ACS is associated with deterioration of a once-stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation

The patient comes to the ED with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerotic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder? a) Unstable angina b) Acute coronary syndrome (ACS) c) ST-segment-elevation myocardial infarction (STEMI) d) Non-ST-segment-elevation myocardial infarction (NSTEMI)

B (The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation.

The patient had a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement? A. Long-term anticoagulation therapy B. Antibiotic prophylaxis for dental care C. Exercise plan to increase cardiac tolerance D. Take β-adrenergic blockers to control palpitations.

a, c (The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life.

The patient had myocarditis and is now experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life? (Select all that apply.) A. Decrease preload and afterload. B. Relieve left ventricular outflow obstruction. C. Control heart failure by enhancing myocardial contractility. D. Improve diastolic filling and the underlying disease process. E. Improve ventricular filling by reducing ventricular contractility

ANS: A In third-degree atrioventricular (AV) block, there is no correlation between the impulse from the atrium to the ventricles and the ventricular rhythm seen. A pacemaker eventually is required.

The patient has a heart rate of 40 beats/minute. The P waves are regular, and the Q waves are regular, but there is no relationship between the P wave and QRS complex. What treatment do you anticipate? A. Pacemaker B. Continue to monitor C. Carotid massage D. Defibrillation

ANS: B These pacer spikes show that the pacemaker is firing and the atrium is responding to the impulse. It is a normal, expected finding in this situation.

The patient has a permanent cardiac pacemaker. On the electrocardiographic tracing, you notice a spike before each P wave. What action should you take? A. Assess the patient for syncope. B. Document the findings. C. Notify the physician. D. Take blood pressure in both arms.

ANS: C The rhythm described is sinus bradycardia. Treatment depends on the patient's response and whether adequate perfusion is occurring. If the patient tolerates the rhythm, no treatment is given.

The patient has an electrocardiographic (ECG) tracing that is 50 beats/minute, the rhythm is regular, and there is a P wave before every QRS complex. The QRS has a normal shape and duration, and the PR interval is normal. What is you response. A. Administer atropine by intravenous push (IVP). B. Administer epinephrine by IVP. C. Monitor the patient for syncope. D. Attach an external pacemaker.

Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response).

The patient has atrial fibrillation with a rapid ventricular response. The nurse knows to prepare for which treatment if an electrical treatment is planned for this patient? Defibrillation Synchronized cardioversion Automatic external defibrillator (AED) Implantable cardioverter-defibrillator (ICD)

ANS: D The chaotic atrial activity results in blood stasis that can lead to embolic events.

The patient has chronic atrial fibrillation (AF). What action do you anticipate? A. Monitoring the PR interval B. Defibrillation with 360 joule C. Teaching the patient to monitor the pulse deficit D. Teaching the patient to take an anticoagulant daily

A, D, E The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)? A. Left ventricular function is documented. B. Controlling dysrhythmias will eliminate HF. C. Prescription for digoxin (Lanoxin) at discharge. D. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge. E. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen.

First-degree AV block In first-degree AV block there is prolonged duration of AV conduction that lengthens the PR interval above 0.20 sec.

The patient has hypokalemia, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm; the P wave is 0.06 seconds (sec) and normal shape; the PR interval is 0.24 sec; the QRS is 0.09 sec. How should the nurse document this rhythm? First-degree AV block Second-degree AV block Premature atrial contraction (PAC) Premature ventricular contraction (PVC)

A The mean arterial pressure (MAP) is calculated using the formula MAP = (systolic BP + 2 diastolic BP)/3. The MAP for the postoperative patient in answer 3 is 67. The MAP in the other three patients is higher than 70 mm Hg.

The standard policy on the cardiac unit states, "Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg." The nurse will need to call the health care provider about the a. postoperative patient with a BP of 116/42. b. newly admitted patient with a BP of 150/87. c. patient with left ventricular failure who has a BP of 110/70. d. patient with a myocardial infarction who has a BP of 140/86.

A The patient data indicate that ineffective coping after the MI caused by anxiety about the impact of the MI is a concern.

Three days after experiencing a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with hygiene activities, saying, "I am too nervous to take care of myself." Based on this information, which nursing diagnosis is appropriate? a. Ineffective coping related to anxiety b. Activity intolerance related to weakness c. Denial related to lack of acceptance of the MI d. Disturbed personal identity related to understanding of illness

choices A, B and C

Thrombolytic enzymes can be used to treat which conditions? a. Pulmonary embolism b. Acute ischemic stroke c. STEMI d. NSTEMI Choices A, B and C

B (Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. The nurse should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to systole.

To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest. b. auscultate by placing the diaphragm of the stethoscope on the lower left sternal border. c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub. d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction.

A The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers.

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patient's a. P wave. b. Q wave. c. P-R interval. d. QRS complex.

B Because patients are more likely to continue physical activities that they already enjoy, the nurse will plan to ask the patient about preferred activities. The goal for older adults is 30 minutes of moderate activity on most days.

To improve the physical activity level for a mildly obese 71-year-old patient, which action should the nurse plan to take? a. Stress that weight loss is a major benefit of increased exercise. b. Determine what kind of physical activities the patient usually enjoys. c. Tell the patient that older adults should exercise for no more than 20 minutes at a time. d. Teach the patient to include a short warm-up period at the beginning of physical activity.

A (The patient's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub.

Two days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first? a. Auscultate the heart sounds. b. Check the patient's temperature. c. Notify the patient's health care provider. d. Give the PRN acetaminophen (Tylenol).

ACE/ARBs, aldosterone antagonists, statins, and omega 3s to treat underlying pathological mechanisms which are the basis for heart failure

Upstream therapy for Atrial fibrillation is using? a. Ion-channel antiarrhythmic drugs such as propafenone to prevent new onset AF b. Procainamide infusions directly to coronary arteries to prevent A fib c. ACE/ARBs, aldosterone antagonists, statins, and omega 3s to treat underlying pathological mechanisms which are the basis for heart failure d. Newer antiarrhythmic drugs such as donedarone, dofetilide, and lbutilide to treat AF that results from use of older, traditional antiarrhythmics e. None of the above

ANS: C The head-up tilt test is used to see whether there is cardioneurogenic syncope with increased venous pooling that occurs in the upright position. This reduces the venous return to the heart. Reference: 839

What is the purpose of the head-up tilt test? A. To determine whether a fluid volume deficit exists B. To assess for dysrhythmias when under stress C. To determine whether there is positional decreased venous return to the heart D. To evaluate for peripheral vascular disease

B. Hypotension and tachycardia Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability.

What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? A. Acute anxiety B. Hypotension and tachycardia C. Peripheral edema and weight gain D. Paroxysmal nocturnal dyspnea (PND)

B. Dissolve clots he may have Thrombolytic drugs are administered within the first 6 hrs after onset of a MI to lyse clots & reduce the extent of myocardial damage

When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: A. Help keep him well hydrated B. Dissolve clots he may have C. Prevent kidney failure D. Treat potential cardiac arrhythmias

ANS: D The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand.

When administering IV nitroglycerin (Tridil) to a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? a. Check blood pressure. b. Monitor apical pulse rate. c. Monitor for dysrhythmias. d. Ask about chest discomfort.

B The contrast dye used for the procedure is iodine based, so patients who have shellfish allergies will require treatment with medications such as corticosteroids and antihistamines before the angiogram.

When admitting a patient for a cardiac catheterization and coronary angiogram, which information about the patient is most important for the nurse to communicate to the health care provider? a. The patient's pedal pulses are +1. b. The patient is allergic to shellfish. c. The patient had a heart attack a year ago. d. The patient has not eaten anything today.

ANS: B The contrast dye used for the procedure is iodine based, so patients who have shellfish allergies will require treatment with medications such as corticosteroids and antihistamines before the arteriogram.

When admitting a patient for a coronary arteriogram and angiogram, which information about the patient is most important for the nurse to communicate to the health care provider? a. The patient's pedal pulses are +1. b. The patient is allergic to shellfish. c. The patient has not eaten anything today. d. The patient had an arteriogram a year ago.

ANS: B Because dysrhythmias are the most common complication of MI, the first action should be to place the patient on a cardiac monitor. The other actions also are important and should be accomplished as quickly as possible. DIF: Cognitive Level: Application REF: 779-780 | 787-788

When admitting a patient with a myocardial infarction (MI) to the intensive care unit, which action should the nurse carry out first? a. Obtain the blood pressure. b. Attach the cardiac monitor. c. Assess the peripheral pulses. d. Auscultate the breath sounds.

50 There are 1500 small blocks in a minute, and the nurse will divide 1500 by 30.

When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ____.

D Because the normal QRS interval is 0.04 to 0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged.

When analyzing the rhythm of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n) a. isoelectric ST segment. b. P-R interval of 0.18 second. c. Q-T interval of 0.38 second. d. QRS interval of 0.14 second.

B Murmurs are caused by turbulent blood flow, such as occurs when blood flows through a damaged valve.

When assessing a newly admitted patient, the nurse notes a murmur along the left sternal border. To document more information about the murmur, which action will the nurse take next? a. Find the point of maximal impulse. b. Determine the timing of the murmur. c. Compare the apical and radial pulse rates. d. Palpate the quality of the peripheral pulses.

ANS: A Both thrills and murmurs are caused by turbulent blood flow, such as occurs when blood flows through a damaged valve.

When assessing a newly admitted patient, the nurse notes a thrill along the left sternal border. To obtain more information about the cause of the thrill, which action will the nurse take next? a. Auscultate for any cardiac murmurs. b. Find the point of maximal impulse. c. Compare the apical and radial pulse rates. d. Palpate the quality of the peripheral pulses.

B The purpose of a PA line is to measure PAWP, so the catheter is floated through the pulmonary artery until the dilated balloon wedges in a distal branch of the pulmonary artery and the PAWP readings are available.

When assisting with insertion of a pulmonary artery (PA) catheter, the nurse identifies that the catheter is correctly placed when the a. PA waveform is observed on the monitor. b. monitor shows a typical PAWP tracing. c. systemic arterial pressure tracing appears on the monitor. d. catheter has been inserted to the 22-cm marking on the line.

ANS: D Administration of oral medications is within the scope of practice for LPNs/LVNs. The initial assessment of the patient, patient teaching, and administration of intravenous anticoagulant medications should be done by the RN. DIF: Cognitive Level: Application REF: 793

When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing action should the nurse delegate to an LPN/LVN? a. Perform the initial assessment of the catheter insertion site. b. Teach the patient about the usual postprocedure plan of care. c. Check the rate on the infusion pump used to administer heparin. d. Administer the scheduled aspirin and lipid-lowering medication.

ANS: B Holter monitoring is used to determine whether the patient is experiencing dysrhythmias such as ventricular tachycardia during normal daily activities. SCD is likely to recur. Heparin will not have any effect on the incidence of SCD, and SCD can occur even when the patient is resting. DIF: Cognitive Level: Application REF: 793-794

When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient a. that sudden cardiac death events rarely reoccur. b. about the purpose of outpatient Holter monitoring. c. how to self-administer low-molecular-weight heparin. d. to limit activities after discharge to prevent future events.

ANS: D The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse. DIF: Cognitive Level: Application REF: 781-782

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having balloon angioplasty, the nurse obtains the following assessment data. Which data indicate the need for immediate intervention by the nurse? a. Pedal pulses 1+ b. Heart rate 100 beats/min c. Blood pressure 104/56 mm Hg d. Chest pain level 8 on a 10-point scale

C (Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain, changes in mental status, and splenomegaly would be associated with embolization from the left-sided valves.)

When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for the development of a. flank pain. b. splenomegaly. c. shortness of breath. d. mental status changes.

a, b, c (Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.)

When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations (select all that apply)? A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages D. Subcutaneous nodules E. Erythema marginatum lesions

C (The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia.)

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. shortness of breath on exertion. d. right upper quadrant tenderness.

D When the catheter is in the wedge position, blood flow past the catheter is obstructed, placing the patient at risk for pulmonary infarction.

When caring for the patient with a pulmonary artery (PA) pressure catheter, the nurse observes that the PA waveform indicates that the catheter is in the wedged position. Which action should the nurse take next? a. Zero balance the transducer. b. Activate the fast flush system. c. Notify the health care provider. d. Deflate and reinflate the PA balloon.

100 beats/min. Since each small block on the ECG paper represents 0.04 secs, 1500 of these blocks represents 1 min. By dividing the # of small blocks (15, in this case) into 1500, the nurse can calc the HR in a pt whose rhythm is regular (in this case, 100).

When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be 60 beats/min. 75 beats/min. 100 beats/min. 150 beats/min.

B (The incidence of rheumatic fever is decreased by treatment of streptococcal infections with antibiotics. Family history is not a risk factor for rheumatic fever. There is no immunization that is effective in decreasing the incidence of rheumatic fever. Teaching about monitoring temperature will not decrease the incidence of rheumatic fever.)

When developing a community health program to decrease the incidence of rheumatic fever, which action would be most important for the community health nurse to include? a. Vaccinate high-risk groups in the community with streptococcal vaccine. b. Teach community members to seek treatment for streptococcal pharyngitis. c. Teach about the importance of monitoring temperature when sore throats occur. d. Teach about prophylactic antibiotics to those with a family history of rheumatic fever.

D Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient's LDL level. Decreases in LDL will help reduce the patient's risk for developing CAD.

When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the a. family history of coronary artery disease. b. increased risk associated with the patient's gender. c. increased risk of cardiovascular disease as people age. d. elevation of the patient's low-density lipoprotein (LDL) level.

D All of the factors contribute to the patient's risk, but only hypertension can potentially be modified to decrease the patient's risk for further expansion of the aneurysm.

When discussing risk factor modification for a 63-year-old patient who has a 5-cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor? a. Male gender b. Turner syndrome c. Abdominal trauma history d. Uncontrolled hypertension

d) Canned chicken noodle soup Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content.

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice? a) Baked flounder b) Angel food cake c) Baked potato with margarine d) Canned chicken noodle soup

B (Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in order to eradicate the bacteria, which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line.

When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention is a priority for the nurse to include? a. Monitor labs for streptococcal antibodies. b. Arrange for placement of a long-term IV catheter. c. Teach the importance of completing all oral antibiotics. d. Encourage the patient to begin regular aerobic exercise.

A, C, D, E, B This order will result in rapid defibrillation without endangering hospital staff.

When preparing to defibrillate a patient. In which order will the nurse perform the following steps? (Put a comma and a space between each answer choice [A, B, C, D, E].) a. Turn the defibrillator on. b. Deliver the electrical charge. c. Select the appropriate energy level. d. Place the paddles on the patient's chest. e. Check the location of other staff and call out "all clear."

D The resting HR does not change with aging, so the decrease in HR requires further investigation.

When reviewing the 12-lead electrocardiograph (ECG) for a healthy 79-year-old patient who is having an annual physical examination, what will be of most concern to the nurse? a. The PR interval is 0.21 seconds. b. The QRS duration is 0.13 seconds. c. There is a right bundle-branch block. d. The heart rate (HR) is 42 beats/minute.

A. Blocks beta-adrenergic stimulation & thus causes decreased heart rate, myocardial contractility, & conduction Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing HR, decreasing myocardial contractility, & slowing conduction

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: A. Blocks beta-adrenergic stimulation & thus causes decreased heart rate, myocardial contractility, & conduction B. Increases norepinephrine secretion & thus decreases BP & HR C. Is a potent arterial & venous vasodilator that reduces peripheral vascular resistance & lowers BP D. Is an angiotensin-converting enzyme inhibitor that reduces BP by blocking the conversion of angiotensin I to angiotensin II

ANS: D Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily.

When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. eggs and other high-protein foods. d. milk, yogurt, and other milk products.

D ECG changes associated with coronary ischemia (such as T-wave inversions and ST segment depression) indicate that the myocardium is not getting adequate oxygen delivery and that the exercise test should be terminated immediately.

When the nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse? a. Patient complaint of feeling tired b. Pulse change from 87 to 101 beats/minute c. Blood pressure (BP) increase from 134/68 to 150/80 mm Hg d. Newly inverted T waves on the electrocardiogram

A Adenosine must be given over 1 to 2 seconds to be effective. The other actions indicate a need for more education about treatment of cardiac dysrhythmias. The RN should hold the diltiazem until talking to the health care provider. The treatment for asystole is immediate CPR. The synchronizer switch should be "off" when defibrillating.

Which action by a new registered nurse (RN) who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias? a. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia b. Obtains the defibrillator and quickly brings it to the bedside of a patient whose monitor shows asystole c. Turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation d. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second degree AV block

C (Because the most common finding on physical examination for a patient with chronic constrictive pericarditis is jugular venous distention, a decrease in JVD indicates improvement. Paradoxical pulse, ST-segment ECG changes,

Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are effective? a. Assess for the presence of a paradoxical pulse. b. Monitor for changes in the patient's sedimentation rate. c. Assess for the presence of jugular venous distention (JVD). d. Check the electrocardiogram (ECG) for ST segment changes.

D (Under the supervision of registered nurses (RNs), UAP check the patient's cardiac monitor and obtain information about changes in heart rate and rhythm with exercise.

Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG) technicians working on the cardiac unit? a. Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome. b. Obtain a list of herbal medications used at home while admitting a new patient with pericarditis. c. Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy. d. Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.

ANS: A Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension.

Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Titrate nesiritide slowly before stopping. d. Teach patient about home use of the drug.

B When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned "on" for cardioversion.

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the "off" position. b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device.

A A patient with fainting episodes is at risk for falls. The nurse will plan to minimize the risk by having assistance whenever the patient up.

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin? a. Instruct the patient to call for assistance before getting out of bed. b. Explain the association between various dysrhythmias and syncope. c. Educate the patient about the need to avoid caffeine and other stimulants. d. Tell the patient about the benefits of implantable cardioverter-defibrillators.

B (Treatment of the IE with antibiotics should be started as quickly as possible, but it is essential to obtain blood cultures before initiating antibiotic therapy to obtain accurate sensitivity results.

Which admission order written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever would be a priority for the nurse to implement? a. Administer ceftriaxone (Rocephin) 1 g IV. b. Order blood cultures drawn from two sites. c. Give acetaminophen (Tylenol) PRN for fever. d. Arrange for a transesophageal echocardiogram.

sublingual nitroglycerine

Which agent is recommended to relieve acute symptoms of MI? a. Short-acting nifedipine b. Isosorbide mononitrate c. Sublingual nitroglycerine d. Clonidine e. Atenolol

calcium channel blockers

Which agents are not recommended as treatment for patients with HFeEF and their use should be... a. Angiotensin II Receptor b. Mineralcorticoid Antagonist c. Beta-Blockers d. Calcium Channel Blockers e. Angiotensin-Converting Enzyme Inhibitors

b & d Ezetimibe (Zetia) should not be used by patients with liver impairment.

Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver (select all that apply)? a) Niacin (Nicobid) b) Ezetimibe (Zetia) c) Gemfibrozil (Lopid) d) Atorvastatin (Lipitor) e) Cholestyramine (Questran)

B The change in temperature of the left hand suggests that blood flow to the left hand is impaired. The flush system needs to be changed every 96 hours.

Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action? a. The flush bag and tubing were last changed 3 days previously. b. The left hand is cooler than the right hand. c. The mean arterial pressure (MAP) is 75 mm Hg. d. The system is delivering only 3 ml of flush solution per hour.

a) A 45-year-old depressed male with a high-stress job The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD.

Which individuals would the nurse identify as having the highest risk for CAD? a) A 45-year-old depressed male with a high-stress job b) A 60-year-old male with below normal homocysteine levels c) A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels d) A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2

ANS: A Continued chest pain suggests that the fibrinolytic therapy is not effective and that other interventions such as percutaneous coronary intervention (PCI) may be needed. Bruising is a possible side effect of fibrinolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST segment elevation indicates that fibrinolysis is occurring and perfusion is returning to the injured myocardium. An increase in cardiac enzyme levels is expected with reperfusion and is related to the washout of enzymes into the circulation as the blocked vessel is opened. DIF: Cognitive Level: Application REF: 782-783

Which information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider? a. No change in the patient's chest pain b. A large bruise at the patient's IV insertion site c. A decrease in ST segment elevation on the electrocardiogram (ECG) d. An increase in cardiac enzyme levels since admission

C MRI is contraindicated for patients with implanted metallic devices such as pacemakers. The other information also will be reported to the health care provider but does not impact on whether or not the patient can have an MRI.

Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI? a. The patient has an allergy to shellfish. b. The patient has a history of atherosclerosis. c. The patient has a permanent ventricular pacemaker. d. The patient took all the prescribed cardiac medications today.

C Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and tachydysrhythmias

Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter? a. The procedure will prevent or minimize the risk for sudden cardiac death. b. The procedure will use cold therapy to stop the formation of the flutter waves. c. The procedure will use electrical energy to destroy areas of the conduction system. d. The procedure will stimulate the growth of new conduction pathways between the atria.

A The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.

Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs? a. The nurse assists the pt to do active rom exercises for all extremities. b. The nurse assists the pt to fill out the application for getting a Medic Alert ID. c. The nurse gives amiodarone (Cordarone) to the pt w/o 1st consulting w/the health care provider. d. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.

less than 100 mg/dL (2.59 mol/L)

Which is the LDL goal for a patient with ischemic heart disease? a. Less than 200mg/dL (5.17mmol/L) b. Less than 160 mg/dL (4.14 mmol/L) c. <130 mg/dL (3.36mmol/L) d. Less than 100 mg/dL (2.59 mmol/L) e. Less than 50 mg/dL (1.29 mmol/L)

D Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation.

Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose 243 mg/dL b. Serum chloride 92 mEq/L c. Serum sodium 134 mEq/L d. Serum potassium 2.9 mEq/L

C UAP serving as telemetry technicians can monitor cardiac rhythms for individuals or groups of patients.

Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as a telemetry technician on the cardiac care unit? a. Decide whether a patient's heart rate of 116 requires urgent treatment. b. Monitor a patient's level of consciousness during synchronized cardioversion. c. Observe cardiac rhythms for multiple patients who have telemetry monitoring. d. Select the best lead for monitoring a patient admitted with acute coronary syndrome.

d. Addition of combination HYD-ISDN to standard therapy in an African-American patient with severe dyspnea with mild activity and systolic HF to decrease risk of morbidity and mortality

Which of the following clinical decisions is evidence based? a. Addition of combo of hydralazine & isosorbide dinitrate (ISDN) to standard therapy is AA pt w/asymptomatic HF to prevent progression of disease b. Addition of combo HYD-ISDN to standard therapy in white pts w/ moderate sympt & systolic HF to decrease the risk of mortality c. Addition of dig .250 mg/day for caucasian pt w/mild to moderate sympt & diastolic HF to decrease mortality d. Addition of combo HYD-ISDN to standard therapy in an African-American pt w/severe dyspnea w/mild activity & systolic HF to decrease risk of morbidity and mortality

Beta-blockers should be continued indefinitely in all patients with prior unstable angina/non-ST segment elevation

Which of the following is TRUE regarding the therapy of Beta-blockers in a post MI population without contraindications: a. Beta-blockers should be continued indefinitely in all patients with prior unstable angina/non-ST segment elevation b. Beta blockers should be discontinued in all patients with prior UA/NSTEMI after a period of symptoms c. Beta blocker should be stopped in all patient with prior STEMI after a period of three years d. None of the above

diltiazem, aspirin

Which of the following is most appropriate initial oral-drug therapy regimen for a 46 yo patient for rate control with paroxysmal atrial fibrillation, no other diseases, and no other risk factors for stroke? a. Digoxin, warfarin b. Diltiazem, aspirin c. Dofetilide, dabigatran d. Dronedarone, enoxaparin e. Disopyramide, apixaban

contact health care provider if weight increases by more than 3lbs in a day or 5lbs in a week

Which of the following statements is most appropriate for patient counseling on non-pharmacologic management of heart failure? a. weight should be kept at 15% above ideal body weight to maintain adequate nutrition b. lower dietary sodium intake to no more than 2g per day c. contact health care provider if weight increases by more than 3lbs in a day or 5lbs in a week d. maintain alcohol intake to no more than 2 drinks per day if diagnosed with alcohol-induced heart-failure e. supervised exercise is recommended including aerobic activity and weight lifting

A. A change in the pattern of her pain A client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.

Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? A. A change in the pattern of her pain B. Pain during sex C. Pain during an argument with her husband D. Pain during or after an activity such as lawn mowing

ANS: D LPN/LVN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient response to exercise after an AMI requires more education and should be done by the RN. Teaching and discharge planning/documentation are higher level skills that require RN education and scope of practice. DIF: Cognitive Level: Application REF: 789-793

Which of these nursing interventions included in the plan of care for a patient who had an acute myocardial infarction (AMI) 3 days ago is most appropriate for the RN to delegate to an experienced LPN/LVN? a. Evaluating the patient's response to ambulation in the hallway b. Completing the documentation for a home health nurse referral c. Educating the patient about the pathophysiology of heart disease d. Reinforcing teaching about the purpose of prescribed medications

amiodarone, digoxin, dabigatran

Which one of the following is the most appropriate oral drug therapy for a 58 yo patient with paroxysmal atrial fibrillation, history of HtN and TIA, a LVEF of 35%, and for whom ventricular rate control therapy has been insufficient to control his symptoms? a. Diltiazem, warfarin b. Digoxin, warfarin c. Amiodarone, digoxin, dabigatran d. Dronedarone, digoxin, aspirin

B The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum.

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Patient with stable angina whose chest pain has recently increased in frequency c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

CHADS 2 VASc score accounts for risk in younger 65-74 are pts

Which statement best describes the differences between CHADS2 adn CHA2DS2-VASc score? a. CHADS 2 score is more sensitive than the CHA2DS2-VASc score b. CHADS 2 VASC score accounts for risk in younger 65-74 age patients c. CHADS2 score accounts for the increased risk of AF in women d. CHA2DS2-VASc score accounts for alcohol use

C (Patients with restrictive cardiomyopathy are at risk for infective endocarditis and should use prophylactic antibiotics for any procedure that may cause bacteremia.

Which statement by a patient with restrictive cardiomyopathy indicates that the nurse's discharge teaching about self-management has been most effective? a. "I will avoid taking aspirin or other antiinflammatory drugs." b. "I will need to limit my intake of salt and fluids even in hot weather." c. "I will take antibiotics when my teeth are cleaned at the dental office." d. "I should begin an exercise program that includes things like biking or swimming."

ANS: C The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF) <40% receive an ACE inhibitor to decrease the progression of heart failure.

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%? a. Need to begin an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors d. Importance of making an annual appointment with the primary care provider

D When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not a clinically significant) finding. Obtaining vital signs and oxygen saturation is not warranted at this point. JVD is an expected finding when a patient performs the

While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the nurse take next? a. Document this finding in the patient's record. b. Obtain vital signs, including oxygen saturation. c. Have the patient perform the Valsalva maneuver. d. Observe for JVD with the patient upright at 45 degrees.

D (Use of stimulant medications should be avoided by patients with MVP because these may exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.)

While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to a. take antibiotics before any dental appointments. b. limit physical activity to avoid stressing the heart. c. take an aspirin a day to prevent clots from forming on the valve. d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

A (Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.)

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to a. promote rest to decrease myocardial oxygen demand. b. teach the patient about the need for anticoagulant therapy. c. teach the patient to use sublingual nitroglycerin for chest pain. d. raise the head of the bed 60 degrees to decrease venous return.

A (Clubbing of the fingers is a loss of the normal angle between the base of the nail and the skin. This finding can be found in endocarditis, congenital defects, and/or prolonged oxygen deficiency.

While doing an admission assessment, the nurse notes clubbing of the patient's fingers. Based on this finding, the nurse will question the patient about which disease process? A. Endocarditis B. Acute kidney injury C. Myocardial infarction D. Chronic thrombophlebitis

D Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. DIF: Cognitive Level: Apply (application) REF: 695 | 697 TOP: Nursing Process: Assessment MSC:

While doing the admission assessment for a thin 76-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take? a. Teach the patient about aneurysms. b. Notify the hospital rapid response team. c. Instruct the patient to remain on bed rest. d. Document the finding in the patient chart.

B The mitral area location is at the intersection of the fifth intercostal space and the midclavicular line. The murmur is a pansystolic murmur.

While listening at the mitral area, the nurse notes abnormal heart sounds at the patient's fifth intercostal space, midclavicular line. After listening to the audio clip, describe how the nurse will document the assessment finding. Click here to listen to the audio clip a. S3 gallop heard at the aortic area b. Systolic murmur noted at mitral area c. Diastolic murmur noted at tricuspid area d. Pericardial friction rub heard at the apex

ANS: B Third-degree heart block represents a loss of communication between the atrium and ventricles.

You obtain a 6-second rhythm strip, and document the following analysis: atrial rate of 70 beats/minute, regular; ventricular rate of 40 beats/minute, regular; QRS of 0.04 second; no relationship between P waves and QRS complexes; and atria and ventricles beating independently of each other. What is the correct interpretation of this rhythm strip? A. Sinus dysrhythmias B. Third-degree heart block C. Wenckebach phenomenon D. Premature ventricular contractions

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: A Moderate doses of two different types of diuretics are more effective than a large dose of one type B This combination promotes diuresis but decreases the risk of hypokalemia C This combination prevents dehydration and hypovolemia D Using two drugs increases osmolality of plasma and the glomerular filtration rate

b (Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.)

A patient who has just been admitted with pulmonary edema is scheduled to receive these medications. Which medication should the nurse question?

carvedilol (Coreg) 3.125 mg

FDA approved agents include carvedilol and metoprolol succinate

which of the following is true regarding B-blockers in heart failure? a. chronic B-blockade increases ventricular mass b. metoprolol tartrate is more efficacious than carvedilol for heart failure c. metoprolol has more potent BP lowering effects compared to carvedilol d. ideally should be started in setting of congestion to aid in diuresis e. FDA approved agents include carvedilol and metoprolol succinate

The nurse is discussing medications with a client with HTN who has a prescription for furosemide daily. The client needs further education when the client states: 1. I know I should not drive after taking furosemide 2. I should be careful not to stand up too quickly when taking furosemide 3. I should take the furosemide in the morning instead of before bed. 4. I need to be sure to also take the potassium supplement that the Dr. prescribed along with my furosemide.

1 (furosemide is a diuretic often prescribed for clients with HTN or HF. The drug should not affect the clients ability to drive safely. Furosemide may cause orthostatic hypotension and clients should be instructed to be careful when changing position. Diuretics should be taken in the morning if possible to prevent sleep disturbances due to the need to get up to void. Furosemide is a loop diuretic that is not potassium sparing; clients should take prescribed K supplements and have serum K levels checked at prescribed intervals)

A client who has diabetes is taking metoprolol for HTN. What should the nurse instruct the client to do? Select all that apply 1. take the tablets with food at the same time each day 2. do not crush or chew the tablets 3. notify the HCP if pulse is 82 bpm 4. Have a blood glucose level drawn every 6-12 months during therapy 5. use an appropriate decongestant if needed 6. Report any fainting spells to the HCP

1,2,4,6 (metoprolol is a beta-adrenergic blocker indicated for HTN, angina and myocardial infarction. The tablets should be taken with food at the same time each day; they should not be chewed or crushed. The HCP should be notified if pulse falls below 50 for several days. Blood glucose should be checked regularly during therapy since increased episodes of hypoglycemia may occur. It may mask evidence of hypoglycemia such as palpitations, tachycardia, and tremor. Use of all OTC decongestants, asthma and cold remedies and herbal preparations must be avoided. Fainting spells may occur due to excercise or stress, and the dosage of the drug may be reduced or discontinued)

ATI: A nurse is planning to admin SC enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? 1. expel the air bubble from the prefilled syringe prior to injecting 2. insert the needle completely into the clients tissue 3. administer the injection in the clients thigh 4. aspirate carefully after inserting the needle into the clients skin

2 (put the bubble to the back of the syringe to seal in med, DO NOT aspirate!!, Inject into abdomen at least 2 inches away from umbilicus)

ATI: A nurse is caring for a client who has a new prescription for captopril for HTN. The nurse should monitor the client for which of the following adverse effects of this medication? 1. hypo K 2. hyper Na 3. neutropenia 4. bradycardia

3 (neutropenia is a serious adverse effect that can occur with an ACE inhibitor. The nurse should monitor the CBC amd teach the client to report indications of infection to the provider. HYPERKALEMIA is a risk. ACE inhibitors cause excretion of Na and water. TACHYCARDIA is an adverse effect of ACE inhibitors)

A client with a history of HTN and peripheral vascular disease underwent an aorto-bifemoral bypass graft. Preop meds include pentoxifylline, metoprolol, and furosemide. On post op day 1, the 1200 VS are as follows: T 98.9 F, HR 132, RR 20, and BP 126/78. Urine output is 50-70 mL/hr. The hemoglobin and hematocrit are stable. The meds have not been prescribed for administration after surgery. Using the SBAR technique for communication, the nurse contacts the HCP and recommends to : 1. continue the pentoxifylline 2. increase the IV fluids 3. restart the metoprolol 4. resume the furosemide

3 (the client is experiencing a rebound tachycardia from abrupt withdrawal of the beta blocker. The beta blocker should be restarted due to the tachycardia, history or HTN, and the desire to reduce the risk of postoperative myocardial morbidity. The bypass surgery should correct the claudication and need for pentoxifylline. The furosemide and increase in fluids are not indicated since the urine output and BP are satisfactory and there is no indication of bleeding. The nurse should also determine the K level before starting furosemide)

A client with cerebral embolus is receiving streptokinase. The nurse should evaluate the client for which expected therapeutic outcomes of this drug therapy? 1. improved cerebral perfusion 2, decreased vascular permeability 3. dissolved emboli 4. prevention of cerebral hemorrhage

3 (thrombolytic agents such as streptokinase are used for clients with history of thrombus formation, CVA's, and chronic atrial fibrillation. The thrombolytic agents act by dissolving emboli. Thrombolytic agents do not directly improve perfusion or increase vascular permeability, nor do they prevent cerebral hemorrhage)

The nurse is working in an internal medicine office. A daughter brings her elderly mother to the Dr. appt. Upon reviewing the medication list, the daughter states, "which medication is prescribed to prevent a stroke?" The nurse is correct to answer which medication? 1. allopurinol 2. claritin 3. ticlopidine 4. methyprednisolone

3 (ticlopidine inhibits platelet aggregation by interfering with adenosine diphosphate release in the coagulation cascade and therefore, is used to prevent thromboembolic stroke. Allopurinol is an antigout medication used to reduce uric acid. Claritin is an OTC allergy medication. Methylprednisolone, a steroid with anticoagulant properties, is not used to treat thromboembolic stroke)

Two weeks ago, a 63-year-old client with heart failure received a new prescription for carvedilol (Coreg its a Beta Blocker) 3.125 mg orally. When evaluating the client in the cardiology clinic, you obtain the following data. Which finding is of most concern? 1. Reports of increased fatigue and activity intolerance 2. Weight increase of 0.5 kg over a 1-week period 3. Sinus bradycardia at a rate of 48 beats/min 4. Traces of edema noted over both ankles

3 (Research indicates that mortality is decreased when clients with heart failure use beta-blocking medications such as carvedilol. When beta-blocker therapy is started for clients with heart failure, heart failure symptoms may initially become worse for a few weeks, so increased fatigue, activity intolerance, weight gain, and edema are not indicative of a need to discontinue the medication at this time. However, the slow heart rate does require further follow-up, because bradycardia may progress to more serious dysrhythmias such as heart block. Focus: Prioritization)

Captopril, furosemide, and metoprolol are prescribed for a client with systolic hear failure. The clients BP is 136/82 and the HR is 65 bpm. Prior to medication administration at 0900, the nurse reviews the following lab tests: NA 140 K 6.8 BUN 18 Creat 1.0 Hgb 12 Hct 37% What should the nurse do first? 1. Administer the medications 2. Call the HCP 3. Withhold the captopril 4. Question the metoprolol dose

3 (The nurse should withhold the dose of captopril; captopril is an ACE inhibitor, and a side effect of the medication is hyperkalemia. The BUN and creatinine which are normal, should be viewed prior to administration since renal insufficiency is another potential side effect of an ACE-1. The HR is within normal limits. The nurse should question the dose of metoprolol if the clients HR is bradycardic. The hbg and hct are normal for a female. The nurse should report the high K level and that the captopril was withheld. FUROSEMIDE WASTES K)

A client is with peripheral artery disease, coronary artery disease and COPD takes theophylline 200 mg. twice daily every day and digoxin 0.5 mg once a day. The HCP now prescribes pentoxifylline. To prevent adverse effects, the nurse should monitor: 1. digoxin level 2. partial thromboplastin time (PTT) 3. serum cholesterol level 4. theophylline level

4 (pentoxifylline can potentiate the effect of theophylline and increase the risk of theophylline toxicity. Therefore the nurse should monitor the clients theophylline level. Pentoxifylline does not interact with digoxin. Pentoxifylline can interact with heparin, and the clients PTT would need to be monitored closely if the client was taking heparin. It doesnt affect cholesterol levels.)

B. Drugs to treat erectile dysfunction The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death.

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? A. High-potassium foods B. Drugs to treat erectile dysfunction C. Nonsteroidal antiinflammatory drugs D. Over-the-counter H2 -receptor blockers

D. Blood pressure The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases.

A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first? A. Urine output B. Heart rhythm C. Breath sounds D. Blood pressure

a. A patient who is cool and clammy, with new-onset confusion and restlessness The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management.

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. A patient who is cool and clammy, with new-onset confusion and restlessness. a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

b. Take and record a daily pulse rate c. Obtain and wear a Medic Alert ID device at all times d. Avoid lifting arm on the side of the pacemaker above shoulder Table 35-13 provides additional discharge teaching guidelines for a patient with a pacemaker.

Which patient teaching points should the nurse include when providing discharge instructions to a patient with a new permanent pacemaker and the caregiver (select all that apply)? a. Avoid or limit air travel b. Take and record a daily pulse rate c. Obtain and wear a Medic Alert ID device at all times d. Avoid lifting arm on the side of the pacemaker above shoulder e. Avoid microwave ovens because they interfere with pacemaker function

A patient is diagnosed with heart failure and is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering the furosemide to the patient, which laboratory result should the healthcare provider to review? A Serum potassium B Serum troponin C Serum sodium D Blood urea nitrogen (BUN)

a (Furosemide may cause hypokalemia, which increases the risk of digoxin toxicity.)

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: A Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. B Increases norepinephrine secretion and thus decreases blood pressure and heart rate. C Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. D Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II

a (Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.)

ß blockers should be avoided in which of the following conditions? A Bronchoconstriction B Hypertension C Angina D Myocardial infarction

a (ß blockers should be avoided in bronchoconstrictive disease. B, C, and D are indications for the use of ß blockers.)

A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: A Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. B Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. C Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin. D Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

b (Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited)

Which pharmacologic therapy is used to decrease blood viscosity and improve red blood cell​ (RBC) flexibility in clients with peripheral vascular disease​ (PVD)? a Clopidogrel​ (Plavix) b Cilostazol​ (Pletal) c Pentoxifylline​ (Trental) d Aspirin

c (Pentoxifylline​ (Trental) is used to decrease blood viscosity and improve RBC flexibility in clients with PVD. Aspirin and clopidogrel​ (Plavix) are medications that inhibit platelet aggregation. Cilostazol​ (Pletal) is a medication that inhibits platelets and vasodilates.)

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: A The same as the client's own baseline level B Lower than the needed therapeutic level C Within the therapeutic range D Higher than the therapeutic range

c (The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.)

The healthcare provider is administering an angiotensin converting enzyme (ACE) inhibitor to a patient diagnosed with heart failure. Which of the following describe the ways in which the ACE inhibitor is therapeutic for the patient who has heart failure? SATA A Increases peripheral vascular resistance B Increases myocardial contractility C Decreases myocardial remodeling D Decreases cardiac output E Decreases cardiac preload F Decreases cardiac workload

c,e,f

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? A Vitamin K B Aminocaproic acid C Potassium chloride D Protamine sulfate

d (The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.)

A patient is prescribed a calcium channel blocker to treat primary hypertension. When teaching the patient about the medication, which of these foods will the healthcare provider advise the patient to avoid? A Eggs B Bananas C Oranges D Grapefruit

d (The levels of calcium channel blockers are increased when grapefruit or grapefruit juice is consumed, potentially causing hypotension.)

When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include

milk, yogurt, and other milk products.

ANS: A Normally, the patient in asystole cannot be successfully resuscitated.

A patient in asystole is likely to receive which drug treatments? A. Atropine and epinephrine B. Lidocaine and amiodarone C. Digoxin and procainamide D. β-Adrenergic blockers and dopamine

a. ACE inhibitor b. Antiplatelet therapy e. Intravenous nitroglycerin

A patient is admitted to the ICU with a diagnosis of unstable angina. Which drug(s) would the nurse expect the patient to receive (select all that apply)? a. ACE inhibitor b. Antiplatelet therapy c. Thrombolytic therapy d. Prophylactic antibiotics e. Intravenous nitroglycerin

all statements are true

The pharmacological effects of verapamil include: a. Decrease heart rate b. Decreased force of myocardial contraction c. Slowed AV conduction d. All statements are true

c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms Rationale: Radiofrequency catheter ablation therapy involves the use of electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias.

Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that a. ventricular bradycardia may be induced and treated during the procedure b. a catheter will be placed in both femoral arteries to allow double-catheter use c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms d. a general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences

A client has an acute arterial occlusion. The healthcare provider has prescribed IV heparin. Before starting the medication, the nurse should: 1. review the blood coagulation laboratory values 2. test the clients stools for occult blood 3. count the clients apical pulse for 1 min 4. check the 24 hour urine output record

1 (before starting heparin infusion, it is essential for the nurse to know the clients baseline blood coagulation values (hct, hgb, RBC and Plt counts). In addition, the partial thromboplastin time (PTT) should be monitored closely during the process. The clients stool would be tested only if internal bleeding is suspected. Although monitoring VS such as apical pulse is important in assessing potential signs and symptoms of hemorrhage or potential adverse reactions to the medication, VS are not the most important data to collect before administering heparin. Intake and output are not important assessments for heparin administration unless the client has fluid and volume problems or kidney disease)

An obese client taking warfarin has dry skin due to decreased arterial blood flow. What should the nurse instruct the client to do? Select all that apply 1. apply lanolin or petroleum jelly to intact skin 2. follow a reduced calorie, reduced fat diet 3. inspect the involved areas daily for new ulcerations 4. limit activities of daily living 5. use an electric razor to shave

1,2,3,5 ( Maintaining skin integrity is important in preventing chronic ulcers and infections. The client should be taught to inspect the skin on a daily basis. The client should reduce weight to promote circulation; a diet lower in calories and fat is appropriate. Because the client is receiving warfarin the nurse should suggest the client use an electric razor. The client with decreased arterial blood flow should be encouraged to participate in ADL's. In fact, the client should be encouraged to consult an exercise physiologist for a program that enhances aerobic capacity of the body)

A client diagnosed with primary (essential) HTN is taking chlorothiazide. The nurse determines teaching about this medication is effective when the client makes which statement? "I will..... select all that apply 1. take my weigh daily at the same time each day 2. not drink alcohol while on this med 3. reduce salt intake in my diet 4. reduce my dosage if I have severe dizziness 5. use sunscreen if I have prolonged exposure to sunlight 6 take the drug late in the evening

1,2,3,5 (chlorothiazide causes increased urination and decreased swelling (edema) and weight loss. It is important to check and record weight two to three times per week at the same time of day with similar clothing. Clients should not drink alcohol or take other meds without the approval of the HCP. Reducing Na intake in the diet helps the diuretic drugs to be more effective and allows smaller doses to be taken.

An obese male client with a history of HF is prescribed a Beta Blocker. Which of the following is important to teach regarding home drug therapy? Select all that apply 1. take your med at the same time each day 2. contact the HCP if you have difficulty getting or maintaing an erection 3. weigh yourself weekly with the same amount of clothes on as the previous time 4. change positions between sitting and standing carefully 5. check your pulse for a full minute before administering your medication 6. monitor blood glucose readings every morning

1,2,4,5 (Beta-blockers treat a variety of conditions including HTN, HF, glaucoma and migraines. Beta blockers are used to slow down the HR, to reduce the force of the hearts contractions, and to reduce blood vessel contraction. Important client instructions include: taking the med at the same time daily, DAILY WEIGHTS, changing positions slowly because of hypotension, and apical pulses for a full minute. A side effect of the medication is sexual difficulties, such as difficulty getting an erection, Monitor the BP not the glucose each morning)

A client is taking clonidine for treatment of HTN. The nurse should teach the client about which common adverse effects of this drug? Select all that apply 1. dry mouth 2. hyperkalemia 3. impotence 4. pancreatitis 5. sleep disturbance

1,3,5 (Clonidine is central acting adrenergic antagonist. It reduces sympathetic outflow from the CNS. Dry mouth, impotence, and sleep disturbances are possible adverse effects. Hyperkalemia and pancreatitis are NOT anticipated with use of this drug)

ATI: A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the HCP? 1. NA 144 2. Urine output 120 mL in 4 hr 3. K 5.2 4. BP 140/90

3

The nurse notes bilateral ankle edema on a client diagnosed with peripheral vascular disease (PVD). The nurse knows this is due to: 1 Decreased blood volume 2 Increased venous pressure 3 Decreased muscular activity 4 Increased venous blood flow

2

ATI: A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other meds. The nurse should recognize that concurrent use of which of the following medications places the client at a risk for digoxin toxicity? 1. phenytoin 2. verapamil 3. warfarin 4. aluminum hydroxide

2 (calcium channel blocker verapamil can increase digoxin levels.. Antacids may decrease absorption and decrease effectiveness)

A client with a history of coronary artery disease (CAD) has been diagnosed with peripheral artery disease. The HCP started the client on pentoxifylline once daily. Approximately 1 hour after recieving the initial dose of pentoxifylline the client reports having chest pain, the nurse should first: 1. initiate the rapid response team 2. contact the HCP 3. have the client rest in bed 4. start an IV infusion of NS

2 (Angina is an adverse reaction to pentoxifylline, which should be used cautiously in clients with CAD. The nurse should report the clients symptoms to the HCP. who may prescribe nitroglycerin and possibly D/C the pentoxifylline. The client should rest until the chest pain subsides. It is not necessary at this point in time to initiate the rapid response team, or start an IV infusion. The clients reports of symptoms should never be dismissed.)

A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15 %. The client is taking warfarin. The expected outcome of this drug is to: 1. decrease circulatory overload 2 improve the myocardial workload 3. prevent thrombus formation 4. regulate cardiac rhythm

3 (Warfarin is an anticoagulant which is used in the treatment of atrial fibrillation and decrease ventricular ejection fraction (<20%) to preven thrombus formation and release of emboli into the circulation. The client may also take other medications as needed to manage heart failure. Warfarin does not reduce circulatory load or improve myocardial workload. Warfarin does not affect cardiac rhythm.)

A. Reduce preload. Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload.

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? A. Reduce preload. B. Decrease afterload. C. Increase contractility. D. Promote vasodilation.

You are preparing to administer the following medications to a client with multiple health problems who has been hospitalized with deep vein thrombosis. Which medication is most important to double-check with another licensed nurse? 1. Famotidine (Pepcid) 20 mg IV 2. Furosemide (Lasix) 40 mg IV 3. Digoxin (Lanoxin) 0.25 mg PO 4. Warfarin (Coumadin) 2.5 mg PO

4 (Anticoagulant medications are high-alert medications and require special safeguards, such as double-checking of medications by two nurses before administration. Although the other medications require the usual medication safety procedures, double-checking is not needed. Focus: Prioritization)

The client with peripheral artery disease is prescribed diltiazem (Calcium Channel Blocker). the nurse should determine the effectiveness of this medication by assessing the client for: 1. relief of anxiety 2. sedation 3 vasoconstriction 4. vasodilation

4 (diltiazem is a calcium channel blocker that blocks the influx of Ca into the cell. In this situation the primary use of diltiazem is to promote vasodilation and prevent spasms of the arteries. As a result of vasodilation, blood, O2, and nutrients can reach the muscles and tissues. )

ANS: C The patient has an elevated low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol, which will increase the risk of coronary artery disease. Although the blood pressure is in the prehypertensive range, the patient's waist circumference and body mass index indicate an appropriate body weight.

42. After reviewing information shown in the accompanying figure from the medical records of a 43-yr-old patient, which risk factor modification for coronary artery disease should the nurse include in patient teaching? a. Importance of daily physical activity b. Effect of weight loss on blood pressure c. Dietary changes to improve lipid levels d. Cardiac risk associated with previous tobacco use

C Assist the patient to a sitting position with arms on the overbed table. The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside.

A 54-year-old male patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? A Perform a bladder scan to assess for urinary retention. B Restrict the patient's oral fluid intake to 500 mL per day. C Assist the patient to a sitting position with arms on the overbed table. D Instruct the patient to use pursed-lip breathing until the dyspnea subsides.

A "The medication prevents blood clots from forming in your heart." Chronic heart failure causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria.

A 70-year-old woman with chronic heart failure and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed for her to continue at home. Which response by the nurse is accurate? A "The medication prevents blood clots from forming in your heart." B "The medication dissolves clots that develop in your coronary arteries." C "The medication reduces clotting by decreasing serum potassium levels." D "The medication increases your heart rate so that clots do not form in your heart."

D. Choose interventions to promote comfort and prevent suffering. The central focus of hospice care is the promotion of comfort and the prevention of suffering.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? A. Taper the patient off his current medications. B. Continue education for the patient and his family. C. Pursue experimental therapies or surgical options. D. Choose interventions to promote comfort and prevent suffering.

c. observe for symptoms of hypotension or angina The rhythm is a 2nddegree (AV) block, type I (i.e., Mobitz I or Wenckebach heart block). gradual lengthening of the PR interval. The nurse should assess for bradycardia, hypotension, and angina. If the patient experiences symptoms, atropine or a temporary pacemaker may be needed.

A patient admitted with ACS has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate 74 beats/min and regular; ventricular rate 62 beats/min and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. The priority nursing intervention would be to a. perform synchronized cardioversion b. administer epinephrine 1 mg IV push c. observe for symptoms of hypotension or angina d. apply transcutaneous pacemaker pads on the patient

A, B, C, D Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety.

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? A Administer ordered morphine sulfate. B Position patient in a semi-Fowler's position. D Instruct patient on the use of relaxation techniques. E Use a calm, reassuring approach while talking to patient.

A. acid-base balance. B. oxygenation status. C. acidity of the blood. E. bicarbonate (HCO3-) in arterial blood.

A student nurse asks the RN what can be measured by arterial blood gases (ABGs). The RN tells the student that the ABGs can measure (select all that apply). A. acid-base balance. B. oxygenation status. C. acidity of the blood. D. glucose bound to hemoglobin. E. bicarbonate (HCO3-) in arterial blood.

D. Right-sided HF An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? A. ADHF B. Chronic HF C. Left-sided HF D. Right-sided HF

The Joint Commission Core Measures state that patients should be taught about prescribed medications, follow-up appointments, weight monitoring, and actions to take for worsening symptoms.

Based on the Joint Commission Core Measures for patients with heart failure, which topics should the nurse include in the discharge teaching plan for a patient who has been hospitalized with chronic heart failure (select all that apply)? a. How to take and record daily weight c. Date and time of follow-up appointment d. Symptoms indicating worsening heart failure e. Actions and side effects of prescribed medications

D. Cardiac vasculopathy Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death.

Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? A. Infection B. Acute rejection C. Immunosuppression D. Cardiac vasculopathy

A. Trachea moved to the left Tracheal deviation is a medical emergency when it is caused by a tension pneumothorax.

During the assessment in the ED, the nurse is palpating the patient's chest. Which finding is a medical emergency? A. Trachea moved to the left B. Increased tactile fremitus C. Decreased tactile fremitus D. Diminished chest movement

D Anorexia and nausea Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity.

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? A Muscle aches B Constipation C Pounding headache D Anorexia and nausea

d.Reduced dyspnea with the head of bed at 30 degrees Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a.Weight loss of 2 lb in 24 hours b.Hourly urine output greater than 60 mL c.Reduction in patient complaints of chest paind. d.Reduced dyspnea with the head of bed at 30 degrees

c. Sinus rhythm with a depressed ST segment Rationale: Typical electrocardiographic (ECG) changes that are seen in myocardial ischemia include ST-segment depression and T-wave inversion.

The nurse is monitoring the ECG of a patient admitted with ACS. Which ECG characteristics would be most suggestive of myocardial ischemia? a. Sinus rhythm with a pathologic Q wave b. Sinus rhythm with an elevated ST segment c. Sinus rhythm with a depressed ST segment d. Sinus rhythm with premature atrial contractions

B. Withhold the dose and report the potassium level. The normal potassium level is 3.5 to 5.0 mEq/L.

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next? A. Withhold the daily dose until the following day. B. Withhold the dose and report the potassium level. C. Give the digoxin with a salty snack, such as crackers. D. Give the digoxin with extra fluids to dilute the sodium level.

d. patients should be sedated if cardioversion is done on a non-emergency basis

The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that a. defibrillation requires a lower dose of electrical energy b. cardioversion is indicated to treat atrial bradydysrhythmias c. defibrillation is synchronized to deliver a shock during the QRS complex d. patients should be sedated if cardioversion is done on a non-emergency basis

A. Take medications as prescribed. The goal for the patient with chronic HF is to avoid exacerbations and hospitalization.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF? A. Take medications as prescribed. B. Use oxygen when feeling short of breath. C. Only ask the physician's office questions. D. Encourage most activity in the morning when rested.

A. Restlessness, tachypnea, tachycardia, and diaphoresis With inadequate oxygenation, early manifestations include restlessness, tachypnea, tachycardia, and diaphoresis, decreased urinary output, and unexplained fatigue.

The patient's arterial blood gas results show the PaO2 at 65 mmHg and the SaO2 at 80%. What early manifestations should the nurse expect to observe in this patient? A. Restlessness, tachypnea, tachycardia, and diaphoresis B. Unexplained confusion, dyspnea at rest, hypotension, and diaphoresis C. Combativeness, retractions with breathing, cyanosis, and decreased output D. Coma, accessory muscle use, cool and clammy skin, and unexplained fatigue

C. Blood pressure the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? A. Urine output B. Lung sounds C. Blood pressure D. Respiratory rate

B. A 72-year-old patient who has four new premature ventricular contractions per minute Early clinical manifestation of hypoxemia include dysrhythmias (e.g., premature ventricular contractions), unexplained decreased level of consciousness (e.g., disorientation), dyspnea on exertion, and unexplained decreased urine output.

Which patient is exhibiting an early clinical manifestation of hypoxemia? A. A 48-year-old patient who is intoxicated and acutely disoriented to time and place B. A 72-year-old patient who has four new premature ventricular contractions per minute C. A 67-year-old patient who has dyspnea while resting in the bed or in a reclining chair D. A 94-year-old patient who has renal insufficiency, anemia, and decreased urine output

c.increased right atrial pressure. jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects increased right atrial pressure.

While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates a.decreased fluid volume. b.jugular vein atherosclerosis. c.increased right atrial pressure. d.incompetent jugular vein valves.

A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by: A Decreased arterial blood flow secondary to vasoconstriction B Decreased arterial blood flow leading to hyperemia C Atherosclerotic obstruction of the arteries D Trauma to the lower extremities

a (Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved)

Which of the following effects of calcium channel blockers causes a reduction in blood pressure? A Increased cardiac output B Decreased peripheral vascular resistance C Decreased renal blood flow D Calcium influx into cardiac muscles

b (One of the effects of calcium channel blockers is to decrease peripheral vascular resistance. A, C, and D describe the opposite effects of calcium channel blockers.)

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principal effects are produced by: A Antispasmodic effect on the pericardium B Causing an increased myocardial oxygen demand C Vasodilation of peripheral vasculature D Improved conductivity in the myocardium

c

Which of the following factors can cause blood pressure to drop to normal levels? A Kidneys' excretion of sodium only B Kidneys' retention of sodium and water C Kidneys' excretion of sodium and water D Kidneys' retention of sodium and excretion of water

c

A patient tells the healthcare provider, "I stopped taking my medication because it kept me up at night with a dry cough." When reviewing the patient's medical record, which of these antihypertensive medications will the healthcare provider identify as the likely cause of this patient's report? A Beta blocker B Calcium channel blocker C Loop diuretic D Angiotensin-converting enzyme (ACE) inhibitor

d

Before receiving the morning​ report, the nurse makes rounds on assigned clients. At the bedside of one​ client, the nurse notes an ampule of vitamin K. What should the presence of this medication indicate to the​ nurse? a The client is receiving intravenous heparin. b The client is receiving​ low-molecular-weight heparin injections. c The client is receiving​ high-dose aspirin therapy. d The client is receiving warfarin.

d

Which of the following parameters is the major determinant of diastolic blood pressure? A Baroreceptors B Cardiac output C Renal function D Vascular resistance

d

A patient diagnosed with mild heart failure is prescribed hydrochlorothiazide (Microzide). The healthcare provider should determine the teaching about the medication has been successful if the patient makes which of these statements? Choose 1 answer: Choose 1 answer: A "I should not worry if I experience a dry cough when taking this medication." B "I might experience swelling in my legs when taking this medication. C . "This medication might cause me to have a decrease in my appetite." D "It is important for me to change positions slowly because I might become dizzy.

d (Hydrochlorothiazide inhibits sodium reabsorption, causing sodium and water (along with potassium and hydrogen ions) to be excreted. The diuretic effect and decrease in fluid volume may cause orthostatic (postural) hypotension. Position changes should be made slowly to prevent falls.)

atropine

All of these are drugs that will slow AV conduction to protect the ventricles in atrial fibrillation EXCEPT: a. B-blockers b. atropine c. nondihydrotide CCB d. digoxin e. all of the above

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about captopril, which statement by the patient indicates that teaching has been effective?

"I will call for help when I need to get up to use the bathroom."

C. Left anterior descending artery

Which of the following arteries primarily feeds the anterior wall of the heart? A. Circumflex artery B. Internal mammary artery C. Left anterior descending artery D. Right coronary artery

The health care provider telephones you with new prescriptions for a client with unstable angina who is already taking clopidogrel (Plavix). Which medication is most important to clarify further with the health care provider? 1. Aspirin (Ecotrin) 162 mg daily 2. Omeprazole (Prilosec) 20 mg daily 3. Metoprolol (Lopressor) 50 mg daily 4. Nitroglycerin patch (Nitrodur) 0.4 mg/hr

2 (Since proton pump inhibitors such as omeprazole affect the metabolism of clopidogrel and decrease its effectiveness, the health care provider may want to discontinue the omeprazole in this client with unstable angina. The other medications should also be verified, but current national guidelines for clients with unstable angina indicate that providers should consider avoiding proton pump inhibitors in those who require clopidogrel. Focus: Prioritization)

beta-blockers

53 y/o F with HTN, UA for longer than 60 minutes. Takes: ASA, HCTZ. What reduced mortality? a. Anticoagulants b. Beta blockers c. Digoxin d. Direct vasodilators

metoprolol (Beta Blocker)

A 74 y/o female presents to the office for HF follow up. She is diagnosed as NYHA FC III. Her BP reads 144/82 mmHg and EF 26%. She takes: Lisinopril, Digoxin, and Furosemide. What else should you add? a. Metolazone (Thiazide) b. Hydralazine and isosorbide (Vasodilator) c. Spironolactone (Aldosterone Antagonist) d. Metoprolol (Beta Blocker) e. Valsartan (Angiotensin Receptor Blocker)

D

An 80-year-old patient with uncontrolled type 1 diabetes mellitus is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done? A. Aortic valve replacement B. Take nitroglycerin for chest pain. C. Open commissurotomy (valvulotomy) procedure D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

thick fibrosis cap

Which of the following is characteristic of an atheroscleortic lesion in a pt with chronic stable angina? a. Thick fibrosis cap b. thrombosis c. Large lipid core d. Plaque rupture e. Platelet aggregation

add isosorbide mononitrate (vasodilator) (next step would be to add ranolazine)

CS is 55 yo man with dyslipidemia and IHS who had an MI 3 months ago. His current medications include Aspirin, Metoprolol, Simvastatin, and sublingual Nitro. He has occasional symptoms of angina with exertion. His blood pressure is 124/70 mmHg and pulse is 60 bpm. Which is the most appropriate pharmacologic intervention? a. Taper off metoprolol and start verapamil b. Add isosorbide mononitrate c. Taper off metoprolol and start nifedipine d. Add diltiazem e. Switch metoprolol to atenolol

slowing depolarization and decreasing the heart rate

Calcium channel blockers affect the SA node by: a. Slowing depolarization and decreasing the heart rate b. Slowing repolarization and decreasing heart rate c. Increase depolarization and decrease heart rate d. Increasing repolarization and decreasing the heart rate

spironolactone has active metabolites and longer half life than eplerenone

Comparing characteristics of the Aldosterone Antagonist Diuretics: a. Eplerenone known for adverse effects of gynecomastia and impotence in men b. Spironolactone has active metabolites and longer half life than eplerenone c. Additional potassium supplements may be needed on eplerenone because it wastes K+ d. All of the above e. None of the above

D The PMI should be felt at the intersection of the fifth intercostal space and the left midclavicular line.

During a physical examination of a 74-year-old patient, the nurse palpates the point of maximal impulse (PMI) in the 6th intercostal space lateral to the left midclavicular line. The most approp action the nurse to take next will be to a. ask the patient about risk factors for atherosclerosis. b. document that the PMI is in the normal anatomic location. c. auscultate both the carotid arteries for the presence of a bruit. d. assess the patient for symptoms of left ventricular hypertrophy.

ANS: A The patient's statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems.

During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of "feeling too tired to get out of bed." Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to weight gain. c. impaired skin integrity related to ankle edema. d. impaired gas exchange related to dyspnea on exertion.

coagulation tests

Each of the following is recommended monitoring for patients requiring chronic amiodarone therapy except a. CXR b. thyroid function tests c. LFTs d. coagulation tests e. electrocardiogram

Beta blocker and ACE inhibitor

Mr. S has a known history of HTN and recent STEMI. Which of the following drugs should initially be started to help treat Mr. S's HTN as well as protect against development of heart failure and symptomatic ventricular dysfunction prior to discharge from hospital? a. Beta blocker and ACE inhibitor b. Beta Blocker and Thiazide diuretic c. ACE and ARB d. ARB and CCB ARB and Peripheral alpha antagonist

ANS: D Because the medication is ordered to improve the patient's angina, effectiveness is indicated if the patient is able to accomplish daily activities without chest pain

Nadolol (Corgard) is prescribed for a patient with angina. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and apical pulse rate. b. fewer complaints of having cold hands and feet. c. improvement in the quality of the peripheral pulses. d. the ability to do daily activities without chest discomfort.

nitrates

Preload is maximally decreased by: a. Nitrates b. Nifedipine c. Verapamil d. Diltiazem e. Hydralazine

start verapamil

Pt is a 68 y/o male with hx of HTN, dyslipidemia, COPD, Dx with Chronic Stable Angina. Takes: Chlorthalidone, Atorvastatin, Salmeterol, Fluticasone, and Albuterol. His BP is 150/90 mmHg and HR 86 bpm. What is the most appropriate change to drug therapy? a. Start propranolol b. Start ranolazine c. Start amlodipine d. Start isosorbide mononitrate e. Start verapamil

combination of these two agents reduces HF, hospitalization, sudden cardiac death and increase mortality

Regarding the combination of Aldosterone Antagonists and ACEi in treatment of HF. a. Combination of these 2 agents should always be avoided because of the risk of hypokalemia b. Combination of these 2 agents reduces HF, hospitalization, sudden cardiac death and increase mortality c. Combo of these 2 increase mortality and sudden cardiac death d. Combination is not used, because it has been found that aldosterone levels are decreased in HF

metoprolol succinate (Toprol XL) and carvedilol (Coreg)

Select the preferred Beta-blocker used for the treatment of CHF: a. Ramipril (Altace) and Lisinopril (Zestril) b. Metoprolol Succinate (Toprol XL) and Carvedilol (Coreg) c. Atenolol and Metoprolol d. None of these are correct

d. assessing the patient's response to the dysrhythmia A (PVC) is a contraction originating in an ectopic focus in the ventricles. When every other beat is a PVC, the rhythm is called ventricular bigeminy.

The ECG monitor of a patient in the cardiac care unit after an MI indicates ventricular bigeminy with a rate of 50 beats/min. The nurse would anticipate a. performing defibrillation b. treating with IV amiodarone c. inserting a temporary transvenous pacemaker d. assessing the patient's response to the dysrhythmia

ANS: A Failure to capture occurs when the electrical charge to the myocardium is insufficient to produce atrial or ventricular contraction. It can result in serious bradycardia, and treatment includes increasing the electrical charge.

The charge nurse is explaining the concept of pacemaker failure to capture to the new graduate. What information should the charge nurse give? A. It occurs when the electrical charge is insufficient. B. It occurs when the pacemaker does not recognize spontaneous heart activity. C. A complication is ventricular tachycardia. D. First-line treatment when this occurs is to turn down the electrical charge.

a) White male The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men.

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic group would the nurse select as the highest priority for this intervention? a) White male b) Hispanic male c) African American male d) Native American female

B (Myocarditis predisposes the heart to digoxin-associated dysrhythmias and toxicity. The other findings are common symptoms of myocarditis and there is no urgent need to report these.)

The nurse is assessing a patient with myocarditis before administering the scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider? a. Leukocytosis b. Irregular pulse c. Generalized myalgia d. Complaint of fatigue

b, c, d, & e During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation.

The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI) (select all that apply)? a) Flushing b) Ashen skin c) Diaphoresis d) Nausea and vomiting e) S3 or S4 heart sounds

B. Assess the extent of arterial blockage Cardiac catheterization is done in clients with angina primarily to assess the extent & severity of coronary artery blockage.

The physician refers the client with unstable angina for a cardiac catherization. The nurse explains to the client that this procedure is being used in this specific case to: a. Open and dilate the blocked coronary arteries b. Assess the extent of arterial blockage c. Bypass obstructed vessels d. Assess the functional adequacy of the valves and heart muscle.

add metoprolol (Beta Blocker)

The pt takes: Lisinopril, Simvastatin, Metformin. Their BP is 140/88 mmHg and HR 80 bpm. She complains of chest pressure and SOB with exertion. Diagnosis of chronic stable angina. Took sublingual nitroglycerin. What is the most appropriate drug to add to therapy? a. Add metoprolol (Beta Blocker) b. Add nifedipine (CCB) c. Add isosorbide mononitrate (Vasodilator) d. Increase lisinopril to 20 mg daily (ACEi) e. Change lisinopril to verapamil (ACEi)

decrease heart rate allowing heart to fill with blood and function more effectively

Therapeutic effects of Beta-blockers in the treatment of heart failure include: a. Decrease heart rate allowing heart to fill with blood and function more effectively b. Increase the release of renin and increase activation of Renin angiotensin aldosterone mechanism c. Increase activation of sympathetic nervous system and induce ventricular remodeling d. Only B and C All of the above

ANS: C Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences.

To assist the patient with coronary artery disease (CAD) in making appropriate dietary changes, which of these nursing interventions will be most effective? a. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary. b. Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes. c. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible. d. Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet.

A Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope.

To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the a. bell of the stethoscope with the patient in the left lateral position. b. diaphragm of the stethoscope with the patient in a supine position. c. bell of the stethoscope with the patient sitting and leaning forward. d. diaphragm of the stethoscope with the patient lying flat on the left side.

D Increased levels of BNP are a marker for heart failure.

To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? a. Troponin b. Homocysteine (Hcy) c. Low-density lipoprotein (LDL) d. B-type natriuretic peptide (BNP)

ANS: C The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed.

While admitting an 82-year-old with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the patient's discharge the nurse will facilitate a a. consult with a psychologist. b. transfer to a long-term care facility. c. referral to a home health care agency. d. arrangements for around-the-clock care.

One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? A Hypocalcemia B Hypermagnesemia C Hypokalemia D Hypernatremia

c (Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.)

A patient is prescribed a thiazide diuretic for the treatment of hypertension. When teaching the patient about the medication, which of the following will the healthcare provider include? Choose 1 answer: A "Take this medication each day with a large glass of water after your evening meal." B "I'll teach you how to take your radial pulse before taking the medication." C "Stop taking this medication if you notice changes in how much you urinate." D "Be sure to include a number of foods that are rich in potassium in your diet."

d (Because thiazide diuretics produce an increase in urine output, the patient should avoid taking the medication in the evening. Potassium is lost in the urine along with sodium and chloride, so the patient should be instructed to include potassium-rich foods in the diet to avoid hypokalemia.)

ANS: A A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/minute d. Urine output of 50 mL over 2 hours

A nurse is presenting health information at a community organization when one of the attendees passes out. The nurse assesses the attendee as being unresponsive. Indicate how the nurse would respond by placing the following actions in chronological order. All options must be used. 1. appoint a person to call 911 2. check for a pulse 3. deliver two rescue breaths 4. check for normal breathing 5. perform chest compressions 6. perform a head tilt-chin lift maneuver

1 5 6 4 3 2 (following the 2015 AHA guidlines for CPR the rescuer would attempt to awaken the victim, then activate the emergency response system, and get an AED or appoint another person to do this. Past guidlines include checking for a pulse, however current guidelines move the pulse check later in the sequence. This stops people from wasting time trying to find a pulse that may not be there. The next step is to give 30 chest compressions. Next the rescuer opens the airway with the head tilt chin maneuver and checks for breathing. If no breathing detected give 2 rescue breaths, check for pulse, and immediately resume chest compressions. The rescuer will use the AED as soon as it arrives)

A nurse is caring for a client who has increased ICP and is receiving mannitol. Which finding should the nurse report to the HCP? 1. blood glucose 150 2. urine output 40 ml/hr 3. dyspnea 4. bilateral equal pupil size

3 (dyspnea is a manifestation of HF and adverse of mannitol, so hold med and notify)

fluids, inotropes

A 68-year-old African American woman is admitted to the hospital for new onset acute decompensated heart failure. Her current medications include felodipine 2.5 mg QD and atorvastatin 20 mg QD. Hemodynamic readings include a PCWP of 16 (2.1 kPa) and a CI of 1.8 L/min/m2. Which of the following is the MOST appropriate treatment plan? a. diuretics, fluids, inotropes b. fluids, inotropes c. fluids, inotropes, vasodilators d. diuretics, vasodilators e. diuretics, inotropes, vasodilators

Ans: A, B, D Feedback: To perform hemodynamic monitoring, a CVP, pulmonary artery, or arterial catheter is introduced into the appropriate blood vessel or heart chamber.

28. When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply. A) A transducer B) A flush system C) A leveler D) A pressure bag E) An oscillator

ATI: A nurse is caring for a hospitalized client who is receiving IV heparin for a DVT. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? 1. vitamin K 2. atropine 3. protamine 4. calcium gluconate

3

The nurse is caring for a client with peripheral artery disease who has recently been prescribed clopidogrel. The nurse understands that more teaching is necessary when the client states: 1. I should not be surprised if I bruise easier or if my gums bleed a little when brushing my teeth 2. it does not really matter if I take this medicine with or without food, whatever works best for my stomach 3. I should stop taking this medicine if it makes me feel weak or dizzy 4. The doctor prescribed this medicine to make my platelets less likely to stick together and helps prevent clots from forming

3 ( weakness, dizziness and headache are common adverse effects of clopidogrel, and the client should report these to the HCP. If they are problematic; in order to decrease the risk of clot formation, the drug must be taken regularly and should not be stopped or taken intermittently. The main adverse effect of clopidogrel is bleeding when brushing teeth. Clopidogrel is well absorbed, and while food may help decrease potential stomach upset the drug may be taken with or without food. Clopidogrel is an antiplatelet agent used to prevent clot formation in clients who have experienced or are at risk for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary syndrome.)

dose needs to be adjusted in renal dysfunction

A 68-year-old woman is admitted for decompensated heart failure, hemodynamic subset IV. Her current medication regimen includes enalapril 10 mg BID, digoxin 0.125 mg QD, carvedilol 12.5 mg BID, furosemide 80 mg BID, and potassium chloride (K-Dur) 40 mEq (40 mmol) BID. Which of the following is TRUE regarding using milrinone therapy in this patient? a. milrinone can interact with her B-blocker therapy due to its B-agonist mechanism b. effects begin to wear off after 72 hours due to tolerance c. dose needs to be adjusted in renal dysfunction d. milrinone is not appropriate to use in subset IV e. both A and C

spironolactone

A 74-year-old woman presents to clinic for heart failure follow-up. She is classified as NYHA FC II. Her blood pressure is 144/82 mm Hg, and most recent EF is 26% (0.26). Her current medication regimen includes lisinopril 20 mg QD, carvedilol 25 mg BID, digoxin 0.125 mg QD, and furosemide 20 mg BID. Which of the following would be the BEST choice to add at this time? a. valsartan b. metolazone c. hydrochlorothiazide d. hydralazine and isosorbide e. spironolactone

A client is being treated for DVT in the left femoral artery. The healthcare provider has prescribed 60 mg of enoxaparin SC. Before adminstering the drug, the nurse checks the clients laboratory results, noted below PTT 12.5 s INR 2.0 s Plt 50,000 Based on these results what should the nurse do? 1. Contact the pharmacist for a lower dose of the medication 2. Administer the medication as prescribed 3. Assess the client for signs of bruising on the extremities. 4. Withhold the dose of the medication and contact the HCP

4 (Based on the laboratory findings prothrombin time and INR are at acceptable anticoagulation levels for the treatment of DVT. However, the platelets are below the acceptable level. Clients taking enoxaparin are at risk for thrombocytopenia. Because of the low platelet level, the nurse should withhold the enoxaparin and contact the HCP.

IV

A 76-year-old man is admitted to the hospital presenting with peripheral and pulmonary edema, decreased urinary output, hypotension, and altered mental status. Pertinent values: PCWP = 32 mm Hg (4.3 kPa), Cardiac index (CI) = 1.8 L/min/m2. Based on his presentation, what hemodynamic subset is he in? a. I b. II c. III d. IV e. II and IV

ANS: B Pulmonary congestion suggests that the patient may be developing heart failure, a complication of myocardial infarction (MI). Hyperglycemia is common after MI because of the inflammatory process that occurs with tissue necrosis.

43. After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? a. Hyperglycemia b. Bilateral crackles c. Q waves on ECG d. Elevated troponin

serum potassium level

A 78 yo women with chronic systolic heart failure and HTN for which she takes metoprolol, lisinopril, and furosemide. Spironolactone therapy is now initiated. Which of the following should be measured in 1 week? a. Left ventricular ejection fraction on echocardiography b. Serum magnesium level c. Serum potassium level d. Left ventricular diastolic volume on nuclear scanning Serum brain natriuretic peptide level

increase his metoprolol

72 y/o Male with CABG, occlusions in ⅔ grafts. Takes: ASA, Metoprolol, Amlodipine, Iso Nitrate, Sublingual Nitroglycerin. BP 130/75 mmHg, HR 92 bpm. Most appropriate adjustment to his tx regimen? a. Add hydrochlorothiazide b. Add lisinopril c. Increase his metoprolol d. Increase his isosorbide mononitrate

B. Start an intravenous line Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces.

A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: A. Call for the doctor. B. Start an intravenous line. C. Obtain a portable chest radiograph. D. Draw blood for laboratory studies.

D. Allergy to iodine or shellfish This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction & possible anaphylaxis is serious & must be assessed before the procedure.

A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure? A. Intake & output B. Baseline peripheral pulse rates C. Height & weight D. Allergy to iodine or shellfish

A. Check the client status & lead placement Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement.

A client wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: A. Check the client status & lead placement B. Press the recorder button on the electrocardiogram console C. Call the physician D. Call a code blue

B. Inhibits synthesis of specific clotting factors in the liver, & it takes 3-4 days for this medication to exert an anticoagulant effect Warfarin works in the liver & inhibits synthesis of four vitamin K-dependent clotting factors. But it takes 3-4 days before the therapeutic effect of warfarin is exhibited.

A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: A. Stimulates the breakdown of specific clotting factors by the liver, & it takes 2-3 days for this to exert to an anticoagulant effect. B. Inhibits synthesis of specific clotting factors in the liver, & it takes 3-4 days for this medication to exert an anticoagulant effect. C. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin D. Has the same mechanism of action as heparin, & the crossover time is needed for the serum level of warfarin to be therapeutic

B. Bathroom privileges & self-care activities On transfer from the CCU, the client is allowed self-care activities & bathroom privileges. Supervised ambulation for brief distances are encouraged and the distances are gradually increased.

A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. The nurse should plan to allow for which client activity? A. Strict bed rest for 24 hours after transfer B. Bathroom privileges and self-care activities C. Ad lib activities because the client is monitored D. Unsupervised hallway ambulation with distances under 200 feet

C. "Does the pain get worse when you breathe in?" Chest pain is assessed by using the standard pain assessment parameters. Pain of pleuropulmonary origin usually worsens on inspiration.

A client with no history of cardiovascular disease comes to the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which question should best help a nurse discriminate pain caused by a non-cardiac problem? A. "Can you describe the pain to me?" B. "Have you ever had this pain before?" C. "Does the pain get worse when you breathe in?" D. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"

Ans: D The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary.

A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care? A) Fluctuations in core body temperature B) Signs and symptoms of esophageal varices C) Signs and symptoms of compartment syndrome D) Perfusion distal to the insertion site

add metoprolol succinate 100 mg daily

A diabetic patient with HTN of exercise intolerance due to shortness of breath. His blood pressure is under poor control (150/90mmHg). He is currently receiving lisinopril and HCTZ. His HR is 90 bpm at rest. He has normal EF and no signs of dyspnea. Which of the following modifications to current regimen is best for the patient? a. Add Amlodipine b. Discontinue HCTZ and add Furosemide 80 mg daily c. Add Metoprolol Succinate 100 mg daily d. Discontinue Lisinopril and add Losartan 50 mg daily

b. will be relieved by rest, nitroglycerin, or both Rationale: Chronic stable angina is chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.

A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia a. will always progress to myocardial infarction b. will be relieved by rest, nitroglycerin, or both c. indicates that irreversible myocardial damage is occurring d. is frequently associated with vomiting and extreme fatigue

C Warm, pink, and dry skin indicates that perfusion to tissues is improved. Since nitroprusside is a vasodilator, the blood pressure may be low even if the medication is effective.

A nurse is assessing a patient who is receiving a nitroprusside (Nipride) infusion to treat cardiogenic shock. Which finding indicates that the medication is effective? a. No new heart murmurs b. Decreased troponin level c. Warm, pink, and dry skin d. Blood pressure 92/40 mm Hg

ANS: B Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft surgery. The other conditions do not place these clients at higher risk for atrial fibrillation.

A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation? a. A 45-year-old who takes an aspirin daily b. A 50-year-old who is post coronary artery bypass graft surgery c. A 78-year-old who had a carotid endarterectomy d. An 80-year-old with chronic obstructive pulmonary disease

D. Taking a blood pressure within 15 mins after nicotine or caffeine ingestion BP should be taken with the client seated with the arm bared, positioned with support at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording.

A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? A. Seating the client with arm bared, supported, and at heart level B. Measuring the blood pressure after the client has been seated quietly for 5 mins C. Using a cuff with a rubber bladder that encircles at least 80% of the limb D. Taking a blood pressure within 15 mins after nicotine or caffeine ingestion

Epinephrine & atropine Normally the pt in asystole cannot be successfully resuscitated. However, administration of epi & atropine may prompt the return of depolarization & ventricular contraction.

A patient in asystole is likely to receive which drug treatment? Epinephrine and atropine Lidocaine and amiodarone Digoxin and procainamide β-adrenergic blockers and dopamine

ANS: A, B, D A client who has premature beats or ectopic rhythms should be taught to stop smoking, manage stress, take medications as prescribed, and report adverse effects of medications.

A nurse is teaching a client with premature ectopic beats. Which education should the nurse include in this client's teaching? (Select all that apply.) a. Smoking cessation b. Stress reduction and management c. Avoiding vagal stimulation d. Adverse effects of medications e. Foods high in potassium

A. Review the intake & output records for the last 2 days. Edema, the accumulation of excess fluid in the interstitial spaces can be measured by intake greater than output & a sudden increase in weight.

A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? A. Review the intake and output records for the last 2 days. B. Change the time of diuretic administration from morning to evening. C. Request a sodium restriction of 1 g/day from the physician. D. Order daily weights starting the following morning.

ANS: C This client is stable and therefore does not require any intervention except to determine the cause of the bradycardia. Bradycardia is often caused by medications. Clients who have multiple chronic diseases are often on multiple medications that can interact with each other.

A nurse performs an admission assessment on a 75-year-old client with multiple chronic diseases. The client's blood pressure is 135/75 mm Hg and oxygen saturation is 94% on 2 liters per nasal cannula. The nurse assesses the client's rhythm on the cardiac monitor and observes the reading shown below: Which action should the nurse take first? a. Begin external temporary pacing. b. Assess peripheral pulse strength. c. Ask the client what medications he or she takes. d. Administer 1 mg of atropine.

ANS: C Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose.

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. "I will be sure to take the medication with food." b. "I will need to eat more potassium-rich foods in my diet." c. "I will call for help when I need to get up to use the bathroom." d. "I will expect to feel more short of breath for the next few days."

ANS: D The bile acid sequestrants interfere with the absorption of other drugs, and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colesevelam may increase the incidence of gastrointestinal side effects such as heartburn. An increased fluid intake is encouraged for patients taking the bile acid sequestrants to reduce the risk for constipation. For maximum effect, colesevelam should be administered with meals. DIF: Cognitive Level: Application REF: 770-771

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when giving the medication? a. Administer the medication at the patient's bedtime. b. Have the patient take this medication with an aspirin. c. Encourage the patient to take the colesevelam with a sip of water. d. Give the patient's other medications 2 hours after the colesevelam.

D The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads.

After providing a patient with discharge instructions on the management of a new permanent pacemaker, the nurse knows that teaching has been effective when the patient states a. "I will avoid cooking with a microwave oven or being near one in use." b. "It will be 1 month before I can take a bath or return to my usual activities." c. "I will notify the airlines when I make a reservation that I have a pacemaker." d. "I won't lift the arm on the pacemaker side up very high until I see the doctor."

B (Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse should immediately assess this patient for other findings such as dyspnea or chest pain.

After receiving report on the following patients, which patient should the nurse assess first? a. Patient with rheumatic fever who has sharp chest pain with a deep breath b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg c. Patient with infective endocarditis who has a murmur and splinter hemorrhages d. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

B (The patient who has just arrived after balloon valvuloplasty will need assessment for complications such as bleeding and hypotension.

After receiving the following information about four patients during change-of-shift report, which patient should the nurse assess first? a. Patient with acute pericarditis who has a pericardial friction rub b. Patient who has just returned to the unit after balloon valvuloplasty c. Patient who has hypertrophic cardiomyopathy and a heart rate of 116 d. Patient with a mitral valve replacement who has an anticoagulant scheduled

a. "I would like to add weight lifting to my exercise program."

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says a. "I would like to add weight lifting to my exercise program." b. "I can only keep my blood pressure normal with medication" c. "I can change my diet to decrease my intake of saturated fats." d. "I will change my lifestyle to reduce activities that increase my stress."

ANS: B Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., amlodipine, nifedipine [Procardia]) are a first-line therapy for this type of angina. Platelet inhibitors, such as aspirin, help prevent coronary artery thrombosis, and -blockers decrease sympathetic stimulation of the heart.

Amlodipine (Norvasc) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that amlodipine will a. reduce the "fight or flight" response. b. decrease spasm of the coronary arteries. c. increase the force of myocardial contraction. d. help prevent clotting in the coronary arteries.

D Rationale: Numbness in the right hand suggests that the perfusion distal to the insertion site is decreased. The Allen test is performed before arterial line insertion, and a positive test indicates normal ulnar artery perfusion.

An arterial catheter is inserted in the right brachial artery to monitor a patient's blood pressure. Which information obtained by the nurse indicates that a complication of arterial pressure monitoring may be occurring? a. The Allen test is positive. b. The mean arterial pressure (MAP) is 102 mm Hg. c. The dicrotic notch is visible in the waveform. d. The right hand is numb.

ANS: C The patient's BP indicates that the dose of metoprolol may need to be decreased because of hypotension.

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ pedal edema b. Heart rate of 56 beats/minute c. Blood pressure (BP) of 88/42 mm Hg d. Complaints of fatigue

Ans: A Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patient's response to medical interventions, such as fluid administration and vasoactive medications.

The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems? A) To assess the patient's response to fluid and drug administration B) To obtain specimens for arterial blood gas measurements C) To dislodge pulmonary emboli D) To diagnose the etiology of chronic obstructive pulmonary disease

b. Obtain vital signs and auscultate for a pericardial friction rub

The nurse is caring for a patient who is 2 days post MI. The patient reports that she is experiencing chest pain. She states, "It hurts when I take a deep breath." Which action would be a priority? a. Notify the physician STAT and obtain a 12-lead ECG b. Obtain vital signs and auscultate for a pericardial friction rub c. Apply high-flow O2 by face mask and auscultate breath sounds d. Medicate the patient with PRN analgesic and reevaluate in 30 minutes

D (About half of all cases of HC have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people.

The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which information obtained by the nurse is most important? a. The patient has a history of a recent upper respiratory infection. b. The patient has a family history of coronary artery disease (CAD). c. The patient reports using cocaine a "couple of times" as a teenager. d. The patient's 29-year-old brother died from a sudden cardiac arrest.

C (Patients with a history of rheumatic fever frequently require ongoing antibiotic prophylaxis, an intervention that necessitates education. This consideration is more important than activity management in preventing recurrence.

What nursing action should the nurse prioritize during the care of a patient who has recently recovered from rheumatic fever? A. Teach the patient how to manage his or her physical activity. B. Teach the patient about the need for ongoing anticoagulation. C. Teach the patient about the need for continuous antibiotic prophylaxis. D. Teach the patient about the need to maintain standard infection control procedures.

A. Reflects electrical impulse beginning at the SA node. C. Reflects atrial muscle depolarization. E. Has duration of normally 0.11 seconds or less.

When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. A. Reflects electrical impulse beginning at the SA node. B. Indicated electrical impulse beginning at the AV node. C. Reflects atrial muscle depolarization. D. Identifies ventricular muscle depolarization. E. Has duration of normally 0.11 seconds or less.

C The posterior tibial site is located behind the medial malleolus of the tibia.

When the nurse is screening patients for possible peripheral arterial disease, indicate where the posterior tibial artery will be palpated. a. 1 b. 2 c. 3 d. 4

B (Sudden onset of flank pain indicates possible embolization to the kidney and may require diagnostic testing such as a renal arteriogram and interventions to improve renal perfusion.

Which assessment finding in a patient who is admitted with infective endocarditis (IE) is most important to communicate to the health care provider? a. Generalized muscle aching b. Sudden onset right flank pain c. Janeway's lesions on the palms d. Temperature 100.7° F (38.1° C)

C (The JVD indicates that the patient may have developed cardiac tamponade and may need rapid intervention to maintain adequate cardiac output.

Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider? a. Pulsus paradoxus 8 mm Hg b. Blood pressure (BP) of 168/94 c. Jugular venous distention (JVD) to jaw level d. Level 6 (0 to 10 scale) chest pain with a deep breath

a. Older woman with disseminated coccidioidomycosis b. Homeless man with history of intravenous drug abuse c.Patient with end-stage renal disease on peritoneal dialysis

Which patients are most at risk for developing infective endocarditis (select all that apply.)? a. Older woman with disseminated coccidioidomycosis. b. Homeless man with history of intravenous drug abuse c. Patient with end-stage renal disease on peritoneal dialysis. d. Man with complaints of chest pain and shortness of breath e. Adolescent with exertional palpitations and clubbing of fingers Incorrect f. Female with peripheral intravenous site for medication administration

ischemic

what is the most common etiology of heart failure? a. drug-induced b. idiopathic c. viral cardiomyopathy d. hypertension e. ischemic